A Decision Support System is Needed for Rapid Triage of Chest Pain Patients Using High Sensitivity Troponin Testing-Based Algorithms

Abstract

Cardiovascular disease is a leading cause of mortality and morbidity
worldwide. In 2013, an estimated 8.14 million people
died from acute myocardial infarction (AMI) globally.1 Emergency
department (ED) is the main portal of entry for patients with
acute chest pain symptoms. Approximately 10% of all emergency
department (ED) patients presented with chest pain complaint.2
However, only 13-23.6% of these patients are finally diagnosed
with AMI.3 Patients with segment (ST) elevation MI (STEMI)
could be rapidly recognized by electrocardiogram (ECG) exam,
but patients with non-ST elevation MI (NSTEMI) could not be
efficiently excluded or included by contemporary cardiac troponin
assays. Contemporary troponin assay could not detect the presence
of cardiac troponins in the peripheral circulation until 6 to 8 hours
after the onset of MI.4 Therefore, patients presenting to the ED
with chest pain usually require serial troponin measurements over
6 to 8 hours before the possibility of MI can be safely excluded.
Failure in early detection results in higher rate of complications
and mortality. The delay in ruling out MI constitutes a major cause
of ED crowding, and the delay in ruling in MI may lead to poor
prognosis. It has been shown early evidence-based management,
including antiplatelet treatment and revascularization, may decrease
mortality, shorten hospitalization, and improve overall outcome.