Impact of European Society of Cardiology/American College of Cardiology guidelines on diagnostic classification of patients with suspected acute coronary syndromes

Ann Clin Biochem 2003;40:156-160
© 2003 Association for Clinical Biochemistry


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Original Articles

P. O. Collinson,
A. C. Rao,
R. Canepa-Anson and
S. Joseph

Departments of Chemical Pathology and Cardiology, Mayday University Hospital, Thornton Heath, Surrey, UK

Background: Assessment of the relative diagnostic accuracy ofinvestigation strategies for patients with suspected acute coronarysyndromes (ACS).

Methods: A prospective observational study followed two groups of patients over a 3-month period in a UK district general hospital. Group one: all admissions with suspected ACS (n = 576); group two: non-cardiac in-patients who were suspected of developing ACS (n = 87). Both were investigated by full clinical history,examination and serial electrocardiographs (ECGs). ConventionalWorld Health Organization (WHO) criteria for myocardial damagewere compared with diagnosis based on cardiac troponin T (cTnT).Clinical discharge diagnosis based on conventional WHO criteriawas compared with the review diagnosis based on measurementof cTnT.

Results: Diagnosis based on WHO criteria missed 58 patients(8·7%) admitted with suspected ACS who had high riskunstable angina. Thirty-three patients (5% of all admissions)who were diagnosed as non-Q wave acute myocardial infarction(AMI) were found to have normal troponin values and to havebeen incorrectly classified as AMI.

Conclusions: Diagnostic strategies based on WHO criteria areinaccurate. The measurement of cTnT in all patients with suspectedACS would have increased the number of those with a diagnosisof AMI by 58 (8·7%), while avoiding inaccurate diagnosisin 33 (5%), therefore producing an absolute increase of 25/663(3·8%) but a relative increase of 58/138 (42%). In patientswith a primary diagnosis of suspected ACS, the overall increasein patients with a diagnosis of AMI will be 55 (9·5%),a relative increase of 55/118 (46·6%) but an absoluteincrease of 36/576 (6·3%).

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