BACKGROUND: The @entity662 unit (CPU) provides rapid diagnostic assessment for @entity1 with acute, undifferentiated @entity662 , using a combination of electrocardiographic (ECG) recording, biochemical markers and provocative cardiac testing. We aimed to identify which elements of a CPU protocol were most diagnostically and prognostically useful. METHODS: The Northern General Hospital CPU uses 2-6 hours of serial ECG/ST segment monitoring, CK-MB(mass) on arrival and at least two hours later, troponin T at least six hours after @entity158 and exercise treadmill testing. Data were prospectively collected over an eighteen-month period from @entity1 managed on the CPU. @entity1 discharged after CPU assessment were invited to attend a follow-up appointment 72 hours later for ECG and troponin T measurement. Hospital records of all @entity1 were reviewed to identify adverse @entity299 over the subsequent six months. Diagnostic accuracy of each test was estimated by calculating sensitivity and specificity for: 1) @entity1187 ( @entity1187 ) with clinical @entity583 and 2) @entity1187 with @entity39 . Prognostic value was estimated by calculating the relative risk of an adverse @entity299 following a positive result. RESULTS: Of the 706 @entity1 , 30 (4.2%) were diagnosed as @entity1187 with @entity583 , 30 (4.2%) as @entity1187 with @entity39 , and 32 (4.5%) suffered an adverse @entity299 . Sensitivities for @entity1187 with @entity583 and @entity39 respectively were: serial ECG/ST segment monitoring 33% and 23%; CK-MB(mass) 96% and 63%; troponin T (using 0.03 ng/ml threshold) 96% and 90%. The only test that added useful prognostic information was exercise treadmill testing (relative risk 6 for @entity204 , non-fatal @entity583 or @entity943 over six months). CONCLUSION: Serial ECG/ST monitoring, as used in our protocol, adds little diagnostic or prognostic value in @entity1 with a normal or non-diagnostic initial ECG. CK-MB(mass) can rule out @entity1187 with clinical @entity583 but not @entity39 (defined as a troponin elevation without @entity583 ). Using a low threshold for positivity for troponin T improves sensitivity of this test for @entity583 and @entity296 . Exercise treadmill testing predicts subsequent adverse @entity299 .

Which diagnostic tests are most useful in a XXXX unit protocol?

@entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity1187 :: ('MESH:D054058', 'Disease') :: ['ACS', 'acute coronary syndrome'] @entity296 :: ('MESH:D009202', 'Disease') :: ['myocardial necrosis'] @entity943 :: ('MESH:D001145', 'Disease') :: ['arrhythmia'] @entity39 :: ('MESH:D009336', 'Disease') :: ['myocyte necrosis'] @entity158 :: ('MESH:D010146', 'Disease') :: ['worst pain'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac events', 'cardiac event'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity204 :: ('MESH:D003643', 'Disease') :: ['cardiac death']
@entity662 :: (MESH:D002637,Disease) :: ['chest pain']
