Study evaluates risk stratification tools for diagnosing acute coronary syndrome

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 and more benign issues. This study assessed 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, which includes heart attacks. The study compared these tools to the unaided clinical judgment of general practitioners.

Main findings: 14 studies were included in the final review.

• Some of the clinical decision rules without troponin improved safety. However, 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 the tests less reliable in primary care settings.

• High-sensitivity 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.