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The value of clinical and laboratory diagnostics for chest pain patients at the emergency department

  • Laurens-Jan C. Jellema EMAIL logo , Barbra E. Backus , A. Jacob Six , Richard Braam , Bjorn Groenemeijer , Hester J. van der Zaag-Loonen , Rene Tio and Jeroen D.E. van Suijlen
Published/Copyright: August 12, 2013
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 52 Issue 2

Abstract

Background: The focus during the diagnostic process for patients with acute chest pain is to discriminate patients who can be safely discharged from those who are at risk for an acute coronary syndrome (ACS). In this study the diagnostic value of the clinical examination is compared with laboratory testing of troponin.

Methods: This study included 710 chest pain patients who presented at the ED of two hospitals in the Netherlands. Clinical examination and laboratory testing were combined in the recently developed HEART-score. The diagnostic values of clinical presentation, troponin and the HEART-score for a major adverse coronary event (MACE) and an ACS within 6 weeks were assessed. Furthermore, the improvement of HEART with the second troponin measurement after 6 h was assessed using the net reclassification improvement (NRI).

Results: The use of HEART (AUCMACE: 0.77; AUCACS: 0.82) obtains a higher diagnostic value than troponin (AUCMACE: 0.72; AUCACS: 0.74) or clinical evaluation (AUCMACE: 0.69; AUCACS: 0.74). Statistical significant different AUCs were obtained when HEART is compared to troponin or clinical evaluation (p<0.01). The use of the second troponin test (after 6 h of admission) within HEART resulted in an improvement of 8.0%.

Conclusions: The HEART-score combines clinical evaluation and results from laboratory testing, which should be used together, to discriminate patients at risk of a cardiac event from patients who can be safely discharged. In addition, it is shown that a second troponin measurement slightly improves the discriminative ability of the HEART-score.

Keywords: clinical diagnosis; HEART; laboratory testing; troponin
Corresponding author: Laurens-Jan C. Jellema, Gelre ziekenhuizen Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands, E-mail:

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Received: 2012-11-14
Accepted: 2013-7-15
Published Online: 2013-8-12
Published in Print: 2014-2-1

©2014 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The ten commandments of laboratory testing for emergency physicians
  4. Review
  5. Critical role of RAGE in lung physiology and tumorigenesis: a potential target of therapeutic intervention?
  6. Opinion Papers
  7. Do we really need high-sensitive troponin immunoassays in the emergency department? Definitely, yes!
  8. Do we really need high-sensitivity troponin immunoassays in the emergency department? Maybe not
  9. General Clinical Chemistry and Laboratory Medicine
  10. Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application
  11. Urinary neutrophil gelatinase-associated lipocalin (NGAL) excretion increases in normal pregnancy but not in preeclampsia
  12. Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
  13. Measurement of amino terminal propeptide of type III procollagen (PIIINP) employing the ADVIA Centaur platform. Validation, reference interval and comparison to UniQ RIA
  14. Cancer Diagnostics
  15. Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
  16. Immunological screening for tumor cells in serous body fluids has added value with the CELL-DYN Sapphire
  17. Cardiovascular Diseases
  18. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department
  19. The concentration of high-sensitivity troponin I, galectin-3 and NT-proBNP substantially increase after a 60-km ultramarathon
  20. Autoantibody prevalence with an improved immunoassay for detecting cardiac troponin-specific autoantibodies
  21. Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
  22. Association of the GCKR rs780094 polymorphism with metabolic traits including carotid intima-media thickness in Japanese community-dwelling men, but not in women
  23. Infectious Diseases
  24. Analysis of antibody response (IgM, IgG, IgG3) to Chikungunya virus using panel of peptides derived from envelope protein for serodiagnosis
  25. Letters to the Editor
  26. A short story on how the H-index may change the fate of scientists and scientific publishing
  27. A new and effective way for preventing pre-analytical laboratory errors
  28. Digital immunofluorescence enables automated detection of antinuclear antibody endpoint titers avoiding serial dilution
  29. Multicenter method evaluation of the ARK™ Methotrexate Immunoassay
  30. Haemoglobinopathies in nonendemic areas in recent years
  31. Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: some results
  32. Effect of recalibration of the hs-TnT assay on diagnostic performance
https://doi.org/10.1515/cclm-2012-0771
Keywords for this article
clinical diagnosis; HEART; laboratory testing; troponin

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The ten commandments of laboratory testing for emergency physicians
  4. Review
  5. Critical role of RAGE in lung physiology and tumorigenesis: a potential target of therapeutic intervention?
  6. Opinion Papers
  7. Do we really need high-sensitive troponin immunoassays in the emergency department? Definitely, yes!
  8. Do we really need high-sensitivity troponin immunoassays in the emergency department? Maybe not
  9. General Clinical Chemistry and Laboratory Medicine
  10. Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application
  11. Urinary neutrophil gelatinase-associated lipocalin (NGAL) excretion increases in normal pregnancy but not in preeclampsia
  12. Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
  13. Measurement of amino terminal propeptide of type III procollagen (PIIINP) employing the ADVIA Centaur platform. Validation, reference interval and comparison to UniQ RIA
  14. Cancer Diagnostics
  15. Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
  16. Immunological screening for tumor cells in serous body fluids has added value with the CELL-DYN Sapphire
  17. Cardiovascular Diseases
  18. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department
  19. The concentration of high-sensitivity troponin I, galectin-3 and NT-proBNP substantially increase after a 60-km ultramarathon
  20. Autoantibody prevalence with an improved immunoassay for detecting cardiac troponin-specific autoantibodies
  21. Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
  22. Association of the GCKR rs780094 polymorphism with metabolic traits including carotid intima-media thickness in Japanese community-dwelling men, but not in women
  23. Infectious Diseases
  24. Analysis of antibody response (IgM, IgG, IgG3) to Chikungunya virus using panel of peptides derived from envelope protein for serodiagnosis
  25. Letters to the Editor
  26. A short story on how the H-index may change the fate of scientists and scientific publishing
  27. A new and effective way for preventing pre-analytical laboratory errors
  28. Digital immunofluorescence enables automated detection of antinuclear antibody endpoint titers avoiding serial dilution
  29. Multicenter method evaluation of the ARK™ Methotrexate Immunoassay
  30. Haemoglobinopathies in nonendemic areas in recent years
  31. Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: some results
  32. Effect of recalibration of the hs-TnT assay on diagnostic performance
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