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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

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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

patients presenting to the ED with chest pain, initially normal EKG and no history of unstable angina 9.1% Acad Emerg Med. 2002 Mar;9(3):203-8. PMID: 11874776
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The sensitivity and specificity of findings for Acute Coronary Syndrome are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %. Post-Test Probability (Predictive Value): %. Switch to display mode.
**Note that calculating probabilities from more than one finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)
Sensitive and Specific Findings
FindingResult SensitivitySpecificity
[ + ] CK-MB Subforms + 0 - 96%98%
[ + ] Troponin I + 0 - 92.3%94.6%
[ + ] Troponin T + 0 - 87%93%
[ + ] CK-MB Subforms + 0 - 91%89%
Specific Findings
FindingResult SensitivitySpecificity
[ + ] Continuous Electrocardiogram + 0 - 68%99%
[ + ] Hypotension + 0 - 3.1%99%
[ + ] Troponin T + 0 - 10.5%98.4%
[ + ] Tachycardia + 0 - 3.2%98%
[ + ] Peripheral Artery Disease + 0 - 7.5%97%
[ + ] Troponin I + 0 - 15.8%96.8%
[ + ] Sgarbossa Criteria + 0 - 37.2%96.6%
[ + ] Troponin T + 0 - 61.7%96.1%
[ + ] Abnormal Prior Stress Test + 0 - 12%96%
[ + ] Pain Radiating to Shoulders or Arms + 0 - 11%96%
[ + ] ST Depression + 0 - 25%95%
[ + ] Tachypnea + 0 - 10%95%
[ + ] Crackles + 0 - 9.2%95%
[ + ] Troponin I + 0 - 57.5%94.3%
[ + ] ECG + 0 - 32%91%
[ + ] CK-MB Subforms + 0 - 21.1%90.5%
[ + ] Myoglobin + 0 - 78%89%
[ + ] Myoglobin + 0 - 26.3%87.3%
[ + ] T-Wave Inversion + 0 - 24%87%
[ + ] Exertional Chest Pain + 0 - 35.3%85%
Sensitive Findings
FindingResult SensitivitySpecificity
[ + ] Trans-Thoracic Echocardiography + 0 - 93%60%
[ + ] No Chest Wall Tenderness + 0 - 91.7%27.8%
Negative Findings
FindingResult SensitivitySpecificity
[ + ] Tenderness to Palpation + 0 - 5.5%80%
Poorly Diagnostic Findings
FindingResult SensitivitySpecificity
[ + ] History of Coronary Artery Disease + 0 - 41%79%
Findings With Unspecified Accuracy
FindingResult SensitivitySpecificity
[ + ] HEART Score No accuracy specified.