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Table 3 Diagnostic performance of physician assessments in percent (95% CI) for ACS within 30 days

From: Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department

  Sensitivity Specificity LR+ LR-
Chest pain history     
Typical of ACS 86 (80–91) 80 (77–82) 4.3 (3.8-5.0) 0.2 (0.1-0.3)
Typical of AMI± 47 (38–57) 90 (88–92) 4.9 (3.7-6.5) 0.6 (0.5-0.7)
Typical of UA≠ 73 (60–84) 87 (85–89) 5.6 (4.5-7.1) 0.3 (0.2-0.5)
Nonspecific for ACS 13 (8–19) 61 (58–64) 0.3 (0.2-0.5) 1.4 (1.3-1.5)
Not suspicious of ACS 1 (0–4) 59 (56–62) 0.02 (0.00-0.12) 1.7 (1.6-1.8)
ECG     
ST-elevation 11 (7–17) 99 (99–100) 15.7 (6.6-37.6) 0.9 (0.8-0.9)
ST-depression 20 (14–27) 98 (97–99) 11.7 (6.6-20.8) 0.8 (0.8-0.9)
T-wave inversion 8 (5–14) 98 (97–98) 3.6 (1.8-7.1) 0.9 (0.9-1.0)
Non-Ischemic* 59 (51–67) 5 (4–6) 0.6 (0.5-0.7) 7.6 (5.5-10.6)
TnT     
Positive initial TnT 42 (34–50) 98 (97–99) (15.0-41.5) 0.7 (0.5- 0.7)
Overall suspicion of ACS     
Obvious ACS 12 (7–18) 100 (99–100) 29 (10–86) 0.9 (0.8-0.9)
Strong suspicion 71 (63–77) 85 (83–87) 4.8 (4.0-5.8) 0.4 (0.3-0.4)
Low suspicion 18 (12–25) 59 (56–62) 0.4 (0.3-0.6) 1.4 (1.3-1.5)
No suspicion 0.3 (0.0-3,2) 56 (53–59) 0.01 (0.00-0.12) 1.8 (1.7-1.9)
  1. ACS, Acute coronary syndrome; LR, likelihood ratio; TnT, Troponin T; UA, Unstable angina.
  2. ± Calculated with AMI as outcome measure.
  3. ≠ Calculated with UA as outcome measure.
  4. *Defined as absence of ST-elevation, ST-depression, T-wave inversion, q-waves and LBBB.