Each year, over 600,000 patients visit Canadian emergency departments (EDs) with chest pain or symptoms suggestive of heart disease. After a thorough assessment in the ED, up to 85% safely have a heart attack ruled out. But, up to a third of these patients — nearly 200,000 per year — are subsequently referred to specialists for unnecessary follow-up testing. This practice strains healthcare resources and delays care for higher-risk patients.

This study aims to create and validate a Canadian-specific risk prediction tool to assess the 30-day risk of Major Adverse Cardiac Events (MACE) in patients who have heart attacks ruled out in the ED. By integrating modern high-sensitivity cardiac troponin assays and accounting for sex-based risk differences, the tool seeks to improve decision-making, reduce unnecessary testing, and ensure resources are allocated to those most in need.

The multicenter study will leverage data from large Canadian hospitals and the CEDRN network to design a tool that incorporates personalized patient characteristics and the latest generation of blood tests for myocardial injury. Its adoption could safely reduce over 50,000 outpatient tests annually, lowering costs and enhancing patient care.

Inclusion criteria

  1. Symptoms of chest pain or of suspected cardiac ischemia (i.e. dyspnea, epigastric pain) undergoing ED evaluation for possible symptomatic coronary disease.
  2. Age 25 or older.

Exclusion criteria

  1. Diagnosis of myocardial infarction made in the emergency department; or any high-sensitivity troponin concentration >115ng/L; or if change between first and second troponin is >3ng/L AND >30% of the initial troponin concentration;
  2. Acute ischemic ECG changes (ST segment elevation or depression, new T-wave inversion, New left bundle branch block; Wellen’s/DeWinter T waves);
  3. Alternative diagnosis identified in the ED (e.g. pneumonia, pulmonary embolism, aortic dissection, pancreatitis; peri/myocarditis);
  4. Acute coronary syndrome or revascularization in previous 30 days;
  5. Expected lifespan < 6 months per treating clinician.

Learn more about this study

ClinicalTrials.Gov entry
Study protocol
Meet the Principal Investigator

Withdraw from this study

If you meet the criteria for inclusion in this study but would prefer not to have your data included, please contact the Research Coordinator, Aysha Macci, at ajmacci@ucalgary.ca.