Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial InfarctionClinical Perspective
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- Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction: Authors ReplyAndrew R Chapman, David E Newby and Nicholas L MillsPublished on May 11, 2017
- RE: Letter by Kin Wa Wong Regarding Article, "Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction"Kin Wa WongPublished on May 8, 2017
- Published on May 11, 2017Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction: Authors Reply
- Andrew R Chapman, BHF Clinical Research Fellow, BHF/University Centre for Cardiovascular Science, Royal Infirmary of Edinburgh
- Other Contributors:
- David E Newby, Professor of Cardiology
- Nicholas L Mills, Professor of Cardiology
We thank Dr Wong for their kind comments on our article. They correctly note the primary outcome was a composite of index type 1 myocardial infarction or type 1 myocardial infarction or cardiac death at 30 days, which occurred in 191 patients. As reported in the results, there were 189 type 1 myocardial infarction on index presentation, and 12 additional events at 30 days (6 type 1 myocardial infarction and 6 cardiac deaths). Of the 12 additional events at 30 days, 10 occurred in patients with type 1 myocardial infarction on index presentation. Patients who had both an index and a 30 day outcome were only counted once, giving a total of 191 patients for the composite primary outcome (189 index type 1 myocardial infarction and two events at 30 days).
We trust this clarifies the data.
Dr Andrew Chapman (on behalf of the co-authors)Competing Interests: Authors of the original manuscript.
- Published on May 8, 2017RE: Letter by Kin Wa Wong Regarding Article, "Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction"
- Kin Wa Wong, Emergency Medicine Physician, Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong
I read with great interest the recent article by Chapman and colleagues. I would like to congratulate the authors for performing a study with promising results. In their prospective observational cohort study, they had proven excellent sensitivity and negative predictive value of the High STEACS pathway.
However, I got a query concerning the rate of total primary outcome (a composite of index type 1 myocardial infarction or type 1 myocardial infarction or cardiac death at 30 days). In the abstract of the article, it stated that the primary outcome occurred in 191/1218 patients. But in the Results part: the adjudicated diagnosis for type 1 myocardial infarction was 189/1218 with 6 subsequent type 1 myocardial infarcts and 6 cardiac deaths at 30 days. As a result, the total primary outcome should be 201/1218 instead of 191/1218. This number of 201/1218 was consistent with that in the Figure S1 in the supplementary material: (adjudicated diagnosis of index type 1 MI: 44+145) + (30 days outcomes of subsequent type 1 MI: 2+4) + (30 days outcomes of cardiac death: 1+5).
Nevertheless, in the Table 2 of the article, for both pathways (high-STEACS and ESC), the rate of actual positive cases for primary outcome which was the sum of true positive + false negative was 191. I hope the authors can solve my confusion on the figures.Competing Interests: None declared.