Prognostic utility of the acute cardiac ischemia time-insensitive predictive instrument ACI-TIPIReport as inadecuate




Prognostic utility of the acute cardiac ischemia time-insensitive predictive instrument ACI-TIPI - Download this document for free, or read online. Document in PDF available to download.

International Journal of Emergency Medicine

, 4:49

First Online: 31 July 2011Received: 08 November 2010Accepted: 31 July 2011

Abstract

BackgroundWe sought to evaluate the test characteristics of the acute cardiac ischemia time-insensitive predictive instrument ACI-TIPI in relation to 30-day major adverse cardiac events MACE among patients who presented to the Emergency Department with symptoms suggestive of an acute coronary syndrome. We then examined the test characteristics of various dichotomous ACI-TIPI cut points.

MethodsWe prospectively recruited a cohort of Emergency Department ED patients with acute chest pain at two urban university hospitals between June and September 2006. Upon enrollment, baseline demographics and cardiac risk factors were collected. An electrocardiogram ECG was performed and analyzed with the built-in ACI-TIPI multiple regression model software. An ACI-TIPI probability score was recorded for each patient. Diagnostic test characteristics of ACI-TIPI for MACE non-ST elevation myocardial infarction NSTEMI, percutaneous coronary intervention, coronary artery bypass grafting, and all-cause mortality within 30 days were determined.

ResultsOf 144 patients enrolled mean age 59.1 ± 14.1 years, 59% men, 19 13% patients suffered MACE within 30 days. Receiver-operating characteristics ROC for ACI-TIPI yielded a c-statistic of 0.69 95% CI 0.59-0.80, p < 0.01. An ACI-TIPI score of ≥ 20 had 100% sensitivity 95% CI 82-100, 100% negative predictive value 95% CI 86-100, and 21% specificity 14-31%.

ConclusionsThese preliminary results suggest that, while ACI-TIPI has limited discriminatory value for MACE overall, a score of < 20 may have 30-day prognostic utility to allow for safe outpatient management in patients with acute chest pain.

Electronic supplementary materialThe online version of this article doi:10.1186-1865-1380-4-49 contains supplementary material, which is available to authorized users.

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Author: Jonathan S Ilgen - Alex F Manini - Udo Hoffmann - Vicki E Noble - Ediza Giraldez - Supapan Nualpring - J Stephen Bohan

Source: https://link.springer.com/article/10.1186/1865-1380-4-49







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