Annals of Family Medicine: Systematic Review Highlights Promise of High-Sensitivity Troponin in Diagnosing Acute Coronary Syndrome in Primary Care Settings

PROVIDENCE, R.I., Sept. 24, 2024 /PRNewswire/ — Findings from a new systematic review, titled “Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome,” published in Annals of Family Medicine, suggest that high-sensitivity troponin tests show promise in diagnosing acute coronary syndrome in primary care settings. However, further validation is required before these tests can be implemented in general practice.

Chest pain is a common but challenging symptom for general practitioners to evaluate, as it can be caused by both serious conditions like acute coronary syndrome. This systematic review assessed the effectiveness of available risk stratification tools in helping general practitioners rule out acute coronary syndrome in patients with chest pain.

Study Overview

Researchers included 14 studies in the review. They assessed the accuracy of clinical decision rules and troponin point-of-care tests, both conventional and high-sensitivity, regarding acute coronary syndrome and major adverse cardiovascular events. When possible, test characteristics were compared to the unaided clinical judgment of general practitioners. The studies involved adult patients presenting with chest pain, aiming to identify which tools could most effectively help general practitioners rule out acute coronary syndrome in primary care settings.

Key Findings

Clinical decision rules: While some of the clinical decision rules without troponin improved safety, none consistently outperformed unaided general practitioner judgment in ruling out acute coronary syndrome.Conventional troponin: Conventional troponin as a standalone test did not meet the desired diagnostic accuracy, making them less reliable in primary care settings (sensitivity <70%).High-sensitivity troponin: High-sensitivity troponin tests showed the highest diagnostic accuracy, with sensitivities of 83.3% to 100% and negative predictive values of 98.8% to 100%. However, further validation in primary care is needed before recommending widespread use.

Accurately diagnosing acute coronary syndrome is critical to prevent unnecessary hospital referrals, reducing health care costs, and ensuring timely treatment. The authors noted, “Finding a tool that exceeds the GP’s accuracy might be challenging, since unaided clinical judgment is already reasonably good with a sensitivity of 75% to 100% and specificity of 18% to 79%. Best diagnostic accuracy might therefore be achieved by combining the GP’s risk assessment with a stratification tool instead of using risk stratification tools as standalone tests.”

Article Cited:

Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome
Simone van den Bulk, MD; Amy Manten, MD; Tobias N. Bonten, MD, PhD; Ralf E. Harskamp, MD, PhD

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals of Family Medicine is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals of Family Medicine is published online six times each year and contains original research from the clinical, biomedical, social, and health services areas, as well as contributions on methodology and theory, selected reviews, essays, and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed for free on the journal’s website, www.AnnFamMed.org.

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SOURCE Annals of Family Medicine