COMPARISON OF SIX DECISION AID RULES FOR DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE CHEST PAIN

J. Hrečko, R. Pudil, J. Dokoupil, P. Pařízek (Hradec Králové)
Tématický okruh: Obecný okruh
Typ: Ústní sdělení - lékařské, CCRID 2022

Objective:  This study aimed to evaluate the accuracy and effectiveness of different strategies for the diagnosis of acute myocardial infarction (AMI) in the elderly in real-life clinical practice.

Methods: Patients older than 70 years presenting to the emergency department with chest pain were included. The performance of six decision aid rules (T-MACS, HEART, EDACS, TIMI, GRACE, and ADAPT) and solo troponin T strategy for diagnosing AMI was evaluated by calculating sensitivity, specificity, odds ratios, negative and positive predictive values.

Results: A total of 250 patients, with a mean age of 78.5 years, were enrolled. Forty-eight patients (19.2%) had an acute myocardial infarction in a 30-day follow-up period. The sensitivity for ruling-out AMI was 100% for T-MACS, HEART, and ADAPT; 97.9% for EDACS, 93.8% for TIMI, and 81.3% for GRACE and solo TnT strategy. For ruling-in AMI, the specificity was 97.5% for T-MACS, 95% for TIMI, 83.2% for HEART, 81.7% for GRACE, and 46% for ADAPT.

Conclusion: T-MACS decision aid had the best performance for rule-out and rule-in diagnostics of AMI. Risk stratification of patients with suspected acute coronary syndrome based on decision aid rules can be used in real-life practice, even in the population of the elderly.