GetTheDiagnosis.org

Welcome, guest.
Login or Sign up to edit.

Add an entry

Search:
 

Tools

Add a finding for this diagnosis

Add prevalence for this diagnosis

Switch to calculator mode to see positive predictive value

Switch to likelihood ratios

Sort findings by Tag

Sort findings by Differential Diagnosis

Jump To

Sensitive and Specific Findings

Specific Findings

Sensitive Findings

Negative Findings

Poorly Diagnostic Findings

Findings With Unspecified Accuracy

Acute Coronary Syndrome: Sensitivity and Specificity

Introduction: ACS is distinguished from stable angina by:

* Rest angina, which is usually more than 20 minutes in duration

* New onset angina that markedly limits physical activity

* Increasing angina that is more frequent, longer in duration, or occurs with less exertion than previous angina

ACS is divided into 3 major categories, namely unstable angina (defined by no serum marker elevation), NSTEMI (serum markers but no ST elevations), and STEMI.

STEMI (ST-segment Elevation Myocardial Infarction, aka ST-elevation MI) - Strict ECG definition: New ST elevation at the J-point in two contiguous leads with the cut-off points: >=0.2 mV in men or >=0.15 mV in women in leads V2-V3 and/or >=0.1 mV in other leads, in the absence of LVH and RBBB.

Cardiac Enzymes timecourse (sens/spec data) from Circulation PMID 10190875:

http://circ.ahajournals.org/cgi/content/full/99/13/1671/T2

Cardiac Enzymes timecourse, from UpToDate:

http://www.uptodate.com/online/content/image.do?imageKey=CARD%2F3187

Other clinical findings: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467 (old) JAMA. 1998 Oct 14;280(14):1256-63. PMID: 9786377

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Cardiac Problem Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
TIMI risk score 12% http://www.mdcalc.com/uanstemitimiscore

http://jama.ama-assn.org/cgi/content/abstract/284/7/835
500 10%
0%
More, Edit...

The sensitivity and specificity of findings for Acute Coronary Syndrome are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
CK-MB Subforms
Duplicate Edit		 96%98%

at 10 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
Troponin I
Duplicate Edit		 92.3%94.6%

at 10 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
Troponin T
Duplicate Edit		 87%93%

at 10 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
CK-MB Subforms
Duplicate Edit		 91%89%

within first 6 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875

Specific Findings

Finding SensitivitySpecificity Comments, Study
Continuous Electrocardiogram Edit 68%99%

continuous monitoring of ST segments

Study: Ann Emerg Med 1998 Jan;31(1):3-11. PMID 9437335
Hypotension Edit 3.1%99%

Systolic < 100 mmHg

Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
Troponin T
Duplicate Edit		 10.5%98.4%

at 2 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
Tachycardia Edit 3.2%98%

heart rate > 120

Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
Peripheral Artery Disease Edit 7.5%97%

Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
Troponin I
Duplicate Edit		 15.8%96.8%

at 2 hours

Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
Sgarbossa Criteria Edit 37.2%96.6%

in patients with LBBB, Sgarbossa et al proposed the following ECG criteria for acute MI:

  • ST elevation >= 1mm concordant with QRS
  • ST depression >= 1mm in V1, V2, or V3
  • ST elevation >= 5mm discordant with QRS

    • In the HERO-2 trial, a positive ECG represented either of the first two criteria, with the last one dropped (previously they had used a scoring system).

    The numbers above are from HERO-2; note that replication in a community setting gave a sensitivity of only 10% with a specificity of 100%.

    Study: N Engl J Med. 1996 Feb 22;334(8):481-7. PMID: 8559200

    J Am Coll Cardiol. 2005 Jul 5;46(1):29-38. PMID: 15992631

    JAMA. 1999 Feb 24;281(8):714-9. PMID: 10052441
    Troponin T
    Duplicate Edit    		 61.7%96.1%

    at 6 hours

    Study: Circulation. 1999 Apr 6;99(13):1671-7. PMID: 10190875
    Abnormal Prior Stress Test Edit 12%96%

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
    Pain Radiating to Shoulders or Arms Edit 11%96%

    radiating to both arms

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467

    Acad Emerg Med. 2002 Mar;9(3):203-8. PMID: 11874776
    ST Depression Edit 25%95%

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
    Tachypnea Edit 10%95%

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
    Crackles Edit 9.2%95%

    or rales

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
    Troponin I
    Duplicate Edit    		 57.5%94.3%

    at 6 hours

    Study: Circulation. 1999 Apr 6;99(13):1671-7. PMID: 10190875
    ECG Edit 32%91%

    ischemic changes

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467

    Ann Emerg Med 1998 Jan;31(1):3-11. PMID 9437335

    CK-MB Subforms
    Duplicate Edit    		 21.1%90.5%

    at 2 hours

    Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
    Myoglobin
    Duplicate Edit    		 78%89%

    within first 6 hours

    Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
    Myoglobin
    Duplicate Edit    		 26.3%87.3%

    at 2 hours

    Study: Circulation 1999 Apr 6;99(13):1671-7. PMID 10190875
    T-Wave Inversion Edit 24%87%

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467
    Exertional Chest Pain Edit 35.3%85%

    patients presenting to the ED with chest pain, initially normal EKG and no history of unstable angina.

    Study: Acad Emerg Med. 2002 Mar;9(3):203-8. PMID: 11874776

    Sensitive Findings

    Finding SensitivitySpecificity Comments, Study
    Trans-Thoracic Echocardiography Edit 93%60%

    by wall motion abnormalities

    in this study PPV of WMA was 31% - specificity is low because of old WMAs

    Study: Circulation. 1991 Sep;84(3 Suppl):I85-92. PMID: 1884510
    No Chest Wall Tenderness Edit 91.7%27.8%

    patients presenting to the ED with chest pain, initially normal EKG and no history of unstable angina.

    Study: Acad Emerg Med. 2002 Mar;9(3):203-8. PMID: 11874776

    Negative Findings

    Finding SensitivitySpecificity Comments, Study
    Tenderness to Palpation Edit 5.5%80%

    pain reproduced on palpation

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467

    Poorly Diagnostic Findings

    Finding SensitivitySpecificity Comments, Study
    History of Coronary Artery Disease Edit 41%79%

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467

    Findings With Unspecified Accuracy

    Finding SensitivitySpecificity Comments, Study
    HEART Score Edit No accuracy specified.

    PLR = 13. threshold 7-10

    Study: JAMA. 2015 Nov 10;314(18):1955-65 PMID: 26547467

     

    The diagnosis database was created by Gavi Kohlberg and Mark Hammer. Copyright 2008-2014, All Rights Reserved. Disclaimer: This site is for health professionals and does not dispense medical advice. The content on this site is provided without warantee, expressed or implied, and without guarantee of accuracy. For questions, email info@getthediagnosis.org or click here.