On the basis of thrombolysis in myocardial infarction (TIMI) score, ECG, and a point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin, Martin Than and colleagues(1) identified patients with chest pain who were at very low risk of a short-term major adverse cardiac event and who might be suitable for early discharge.
We are a little concerned about missing TIMI score data. The score includes “three or more risk factors for coronary artery disease” and “significant coronary stenosis at previous angiography” (yes=1, no=0). We wonder whether a patient without a regular health check was regarded by Than and colleagues as scoring 0 or 1? This could be an important issue considering the threshold considered (TIMI score ≥1=positive). We know, for instance, that people of low socioeconomic status have a lower access to health care, yet they have more risk factors for coronary heart disease.(2—4) Without a regular check-up, these people might have had a lower TIMI score than they should have.
In conclusion, we think that the accelerated diagnostic protocol should take into account the absence of medical follow-up to consider factors such as health inequalities.
We declare that we have no conflicts of interest.
References
1 Than M, Cullen L, Reid CM, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet 2011; 377: 1077-1084. Summary | Full Text | PDF(200KB) | CrossRef | PubMed
2 Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993; 88: 1973-1998. PubMed
3 Tyroler HA. The influence of socioeconomic factors on cardiovascular disease risk factor development. Prev Med 1999; 29: S36-S40. CrossRef | PubMed
4 Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T. Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community Health 2011; 65: 301-309. PubMed
