_id

683a15fdc782e11e38d1b100

id

1857

title

ADAPT Protocol for Cardiac Event Risk

full_title

ADAPT Protocol for Cardiac Event Risk

short_title

ADAPT Protocol

med_description

Assesses chest pain patients at 2 hours for risk of cardiac event.

short_description

2-hour rule out for low risk chest pain.

slug

adapt-protocol-cardiac-event-risk

description

The ADAPT Protocol for Cardiac Event Risk uses a 2-hour accelerated diagnostic protocol to assess patients with chest pain for 30 day risk of cardiac event.

keywords

adapt trial, 2 hour trial acs, troponin acs score, adapt troponin, adapt adp, adapt score, adapt calculator, accelerated acs diagnosis, accelerated acs dx, adapt troponin calc, adapt protocol, adapt calc, trop adapt, trop adapt calc, troponin only calc, troponin calculator adapt, adapt trial, 2 hour ACS dx, 2 hour acs diagnosis, 2 hr acs dx, 2 hr acs diagnosis, ACS r/o 2hr, ACS rule out 2 hour, ACS rule out 2 hr, ADAPT Protocol for Cardiac Event Risk, adapt protocol, adapt accelerated protocol, adapt cardiac event, adapt cardiac event risk, adapt risk, adapt protocol risk, adapt protocol calc, adapt protocol calculator, adapt protocol score, adapt mdcalc

complaint

[ "Chest Pain" ]

formula

Addition of the selected points: *cTnI level at 0 and 2 hours above institutional cutoff for elevated troponin.**ST-segment depression of at least 0.05 mV in ≥2 contiguous leads (including reciprocal changes), T-wave inversion of at least 0.1 mV, or Q waves ≥30 ms in width and ≥0.1 mV in depth in at least 2 contiguous leads.

evidence

• The ADAPT accelerated diagnostic protocol (ADP) was 99.7% sensitive for identifying a low-risk population of chest pain patients.
• 15.3% of patients overall in the study had the primary outcome event of “major adverse cardiac event” (MACE) which includes MI, emergency revascularization, death, ventricular arrhythmia, cardiac arrest, cardiogenic shock, or high-degree AV block.
• The ADAPT accelerated diagnostic protocol was able to identify 20% of the entire cohort of 1,975 patients as “low risk.”
• One patient was classified as low risk who then had an elevated troponin at 12 hours, had stenting of the right coronary and circumflex arteries, and had “no further cardiac problems during 1 year of follow-up.”
• If a TIMI Score of 1 was used instead of 0, the false-negative rate was 3%.

measurements

[]

information

*Per Than 2012.

**Per Cullen 2013. The study examined patients with TIMI 0 or 1, with no reported data for patients with TIMI >1 (presuming according to TIMI data, risk of MACE increases with increasing TIMI Score).

***Per Than 2012. In the original paper, 15.3% of patients studied (302 of 1,975 total) had a MACE, and only 1 patient was identified as low risk.

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22578923", "text": "Than M, et. al. 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker : The ADAPT Trial. J Am Coll Cardiol. 2012 Jun 5;59(23):2091-8. doi: 10.1016/j.jacc.2012.02.035. Epub 2012 May 9." } ], "Other References": [ { "href": "", "text": "" } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23583250", "text": "Cullen L, Mueller C, Parsonage WA, Wildi K, Greenslade JH, Twerenbold R,Aldous S, Meller B, Tate JR, Reichlin T, Hammett CJ, Zellweger C, Ungerer JP, Rubini Gimenez M, Troughton R, Murray K, Brown AF, Mueller M, George P, Mosimann T, Flaws DF, Reiter M, Lamanna A, Haaf P, Pemberton CJ, Richards AM, Chu K, Reid CM, Peacock WF, Jaffe AS, Florkowski C, Deely JM, Than M. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol. 2013 Oct 1;62(14):1242-9. doi: 10.1016/j.jacc.2013.02.078. Epub 2013 Apr 10. PubMed PMID: 23583250." } ], "Validations": [] }

pearls

• Included patients ≥18 years of age with at least 5 minutes of symptoms that could be possible ACS.
• Patients perceived to be “high risk” were not excluded unless EKG showed ST-Elevation Myocardial Infarction (STEMI).
• If patient was unsure about a diagnosis (like “history of hypertension,”) this was assumed to be “No.”
• EKG changes were defined as ST-segment depression of at least 0.05 mV in ≥2 contiguous leads (including reciprocal changes), T-wave inversion of at least 0.1 mV, or Q waves ≥30 ms in width and ≥0.1 mV in depth in at least 2 contiguous leads.
• 3/4 of patients in the low-risk group still received follow-up testing within 30 days (most with an outpatient stress test).

usecase

The ADAPT Score and Accelerated Diagnostic Protocol can be used to evaluate patients with chest pain and potentially identify 20% of patients who are low-risk and can be evaluated with a 0-hour and 2-hour troponin test along with EKG and TIMI Risk Scores (for STEMI and UA/NSTEMI).

reasons

Up to 20% of chest pain patients may be able to be safely ruled out for MI and ACS within 2 hours of arrival in the ED, reducing length of stay dramatically without adverse outcome.

next_advice

Barring other concerning features for acute coronary syndrome or other life-threatening causes of chest pain (pneumothorax, pulmonary embolism, cardiac tamponade, aortic dissection, esophageal rupture, etc.), patients that meet the low-risk criteria can be considered for discharge with close follow-up with their primary care physician after negative 0h and 2h troponin testing.

Patients who do not meet the low-risk criteria should be ruled-out for myocardial infarction with serial EKGs and biomarkers and risk stratified as per normal chest pain guidelines and protocols.

next_actions

next_management

• For low-risk patients: consider other causes of chest pain due to aortic, esophageal, pulmonary, cardiac, and abdominal, and musculoskeletal sources prior to discharge.
• For non-low-risk patients: Treat as per usual chest pain protocols, including but not limited to consideration of aspirin, nitroglycerin, and serial EKGs and biomarkers at minimum.

diseases

[ "Acute Coronary Syndrome", "Myocardial Infarction" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "Abnormal troponin at 0 or 2 hours", "md_calc_info_concept": null, "name": "abnormal_troponin", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Ischemic changes on EKG", "md_calc_info_concept": null, "name": "abnormal_ekg", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "<calculator id='111'>TIMI Risk Score for UA/NSTEMI</calculator><br/>Note: The TIMI Risk Score for UA/NSTEMI includes cardiac enzymes and ST deviation which are listed above and therefore excluded from the TIMI inputs below.", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 0, "label_en": "Age ≥65 years", "md_calc_info_concept": null, "name": "age_65", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "≥3 CAD risk factors", "md_calc_info_concept": null, "name": "cad_risk_factors", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Hypertension, hypercholesterolemia, diabetes, family history of coronary artery disease, or current smoker", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Known CAD (stenosis ≥50%)", "md_calc_info_concept": null, "name": "known_cad", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Aspirin use in past 7 days", "md_calc_info_concept": null, "name": "aspirin_use", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Severe angina (≥2 episodes in 24 hrs or persisting discomfort)", "md_calc_info_concept": null, "name": "angina", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" } ]

instructions

published

2022-04-21T20:29:03.096Z

purpose

[ "Algorithm", "Prognosis", "Rule Out" ]

search_terms

[ "acs", "troponin", "cp", "chest pain" ]

seo

{ "keywords_en": "adapt trial, 2 hour trial acs, troponin acs score, adapt troponin, adapt adp, adapt score, adapt calculator, accelerated acs diagnosis, accelerated acs dx, adapt troponin calc, adapt protocol, adapt calc, trop adapt, trop adapt calc, troponin only calc, troponin calculator adapt, adapt trial, 2 hour ACS dx, 2 hour acs diagnosis, 2 hr acs dx, 2 hr acs diagnosis, ACS r/o 2hr, ACS rule out 2 hour, ACS rule out 2 hr, ADAPT Protocol for Cardiac Event Risk, adapt protocol, adapt accelerated protocol, adapt cardiac event, adapt cardiac event risk, adapt risk, adapt protocol risk, adapt protocol calc, adapt protocol calculator, adapt protocol score, adapt mdcalc", "meta_description_en": "The ADAPT Protocol for Cardiac Event Risk uses a 2-hour accelerated diagnostic protocol to assess patients with chest pain for 30 day risk of cardiac event." }

specialty

[ "Cardiology", "Emergency Medicine", "Hospitalist Medicine", "Internal Medicine" ]

departments

[ "Cardiac" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1858, "short_title_en": "EDACS", "slug": "emergency-department-assessment-chest-pain-score-edacs" }, { "calcId": 111, "short_title_en": "TIMI Score for UA/NSTEMI", "slug": "timi-risk-score-ua-nstemi" }, { "calcId": 1856, "short_title_en": "Vancouver Chest Pain Rule", "slug": "vancouver-chest-pain-rule" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology" ]

cleaned_use

[ "The ADAPT Score and Accelerated Diagnostic Protocol can be used to evaluate patients with chest pain and potentially identify 20% of patients who are low-risk and can be evaluated with a 0-hour and 2-hour troponin test along with EKG and TIMI Risk Scores (forSTEMIandUA/NSTEMI)." ]

pub

false