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

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.