Identifying Acute Cardiac Ischaemia in the Emergency Department
The ACI diagnostic instrument appears to be effective in the diagnosis of cardiac ischaemia. Other technologies that appear effective include the ACI-TIPI, the pre-hospital ECG, the Goldman chest pain protocol, and the ECG exercise test. Level of evidence: "B"A systematic review 1 including 78 studies was abstracted in DARE. Of the various diagnostic technologies evaluated only 5 met the standard of evaluation consisting of both emergency department diagnostic performance and clinical impact data obtained in high-quality or substantial studies: the original ACI (acute cardiac ischaemia) diagnostic instrument, the ACI-TIPI, the pre-hospital ECG; the Goldman chest pain protocol, and the ECG exercise test. The original ACI predictive instrument was excellent for diagnostic performance and had a substantial clinical impact.
Comment: The quality of evidence is upgraded by large magnitude of effect.
References
- Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD. An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: a report from a National Heart Attack Alert Program Working Group. Ann Emerg Med 1997 Jan;29(1):13-87. [PubMed] [DARE]