Article Figures & Data
Figures
- Figure 1.
Flowchart of systematic review of the literature.
ASR = Active learning for Systematic Reviews.
Tables
SUPPLEMENTAL DATA IN PDF FILE BELOW
Supplemental Appendix 1. Search components in PubMed and EMBASE
Supplemental Appendix 2. ASReview
Supplemental Table 1. Components of risk stratification tools
Supplemental Table 2. Cardiac troponin assays and threshold values
Supplemental Table 3. Risk of bias and applicability assessment
- vandenbulk_supp.pdf -
PDF file
- vandenbulk_supp.pdf -
VISUAL ABSTRACT IN PNG FILE BELOW
- van_den_Bulk_Final_VA.png -
PNG file
- van_den_Bulk_Final_VA.png -
PLAIN LANGUAGE ARTICLE SUMMARY
Systematic Review
High-Sensitivity Troponin Shows Promise in Diagnosing Acute Coronary Syndrome In Primary Care Settings
Background and Goal: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, which includes heart attacks, and more benign issues. Accurately identifying acute coronary syndrome is critical to prevent unnecessary hospital referrals and reduce health care costs. This study aimed to assess the effectiveness of various risk stratification tools, including clinical decision rules and troponin tests, in helping general practitioners rule out acute coronary syndrome in patients with chest pain.
Study Approach: Researchers conducted a systematic review of studies involving adult patients presenting with chest pain in primary care settings. The review included studies that examined the diagnostic accuracy of different clinical decision rules and troponin point-of-care tests, both conventional and high-sensitivity, in identifying acute coronary syndrome. The study compared these tools to the unaided clinical judgment of general practitioners.
Main Findings:14 studies out of 1,204 screened were included in the final review.
• 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 as a standalone test did not meet the desired diagnostic accuracy, making them less reliable in primary care settings.
• High-sensitivity troponin (hs-troponin) tests demonstrated the highest diagnostic accuracy. However, this finding requires further prospective validation in primary care before it can be recommended for widespread use.
Why It Matters:Although high-sensitivity troponin tests hold promise, they are not yet ready to replace clinical judgment or be used independently in primary care settings without further validation. The best diagnostic accuracy might be achieved by combining general practitioners’ risk assessments with these stratification tools, rather than using them as standalone tests. Ensuring the accuracy, additional value and validation of these tools is essential for improving patient outcomes and reducing unnecessary health care costs.
Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome
Simone van den Bulk, MD, et al
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Visual abstract showcasing key findings from this study:
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