During the discussion period, an audience member mentioned another chest pain decision rule that was published earlier this year, based on observational data from 3,582 consecutive patients in 14 EDs in nine countries in the Asia-Pacific region. This rule uses a structured pretest probability scoring method involving the Thrombolysis in Myocardial Infarction score, electrocardiography, and a point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin (Lancet 2011;377:1077-84).
"It will be interesting to compare all these rules at some point," Dr. Scheuermeyer said.
The two SAEM conference papers were presented at a session titled "Defining the Low-Risk Cardiac Patients." In an interview, session moderator Dr. Alexander T. Limkakeng Jr. said that finding a reliable decision rule on low-risk chest pain has been called the Holy Grail of acute coronary research.
"It was exciting to see two high-quality studies done at different centers at the same session. It was especially so because both studies not merely derived but also validated rules," said Dr. Limkakeng, director of acute care research in the emergency medicine division at Duke University, Durham, N.C.
"It felt like the beginning of a paradigm shift. I sensed that for the first time, many researchers who were present now feel it really is possible to identify some chest pain patients in the ED who could be safely discharged using only history, ECG, and troponin data. Of course, further external validation is necessary, but it is exciting to see."
Dr. Hess’ study was jointly funded by an Emergency Medicine Fellow award from the American Heart Association and the Society for Academic and Emergency Medicine, the Ontario Innovation Fund, and the University of Ottawa. He had no other disclosures. Dr. Scheuermeyer had no disclosures. Dr. Limkakeng disclosed receiving financial support from Roche for a cardiac biomarker study and from the National Institutes of Health for the ProCESS trial.