ADAPT Algorithm for Cardiac Event Risk

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A simplified model to indicate the risk of a major adverse coronary event (MACE)

Clinical indication
The Calculator is intended to be used for patients presenting to the Emergency Department with Chest Pain aged 18 years or older.

Research authors: Martin Than, Louise Cullen, Sally Aldous, William A. Parsonage, Christopher M. Reid, Jaimi Greenslade, Dylan Flaws, Christopher J. Hammett, Daren M. Beam, Michael W. Ardagh, Richard Troughton, Anthony F. T. Brown, Peter George, Christopher M. Florkowski, Jeffrey A. Kline, Frank Peacock, Alan S. Maisel, Swee Han Lim, Arvin Lamanna, A. Mark Richards

Version: 2.5

Public
Cardiology
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V-2.5-158.24.05.31

(01)08719327522721(8012)v2.5(4326)240531(240)158

Download the User manual and consult the Intended purpose.

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Intended purpose
Electronic label
Release Notes
User manual
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30-day risk of MACE is

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30-day risk of MACE is %

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Conditional information

It should be noted that, while the ADAPT can be used with contemporary cardiac troponin assays, it performs better with high-sensitivity cardiac troponin assays (hs-cTn), especially for the Fairly Low Risk category.

In the derivation study of Than et al. (2012) using contemporary (not high-sensitivity) troponin assays (Abbott ARCHITECT cTnI assay and DxI Access Accu cTnI assay)
Low Risk: 1 out of 392 patients had a Major Adverse Cardiac Event within 30 days (0.26% risk)
Fairly Low Risk: 8 out of 367 patients had a Major Adverse Cardiac Event within 30 days (2.18% risk)
High Risk: 293 out of 1216 patients had a Major Adverse Cardiac Event within 30 days (24.1% risk)

In a Validation study by Cullen et al. (2013) using the ARCHITECT High Sensitive STAT Troponin-I assay
Low Risk: 0 out of 550 patients had a Major Adverse Cardiac Event within 30 days (0% risk)
Fairly Low Risk: 3 out of 479 patients had a Major Adverse Cardiac Event within 30 days (0.63% risk)
High Risk: 400 out of 1515 patients had a Major Adverse Cardiac Event within 30 days (26.4% risk)

A pooled analysis of multiple studies containing 3163 patients with a total of 487 events found a sensitivity of 99.79% and a negative predictive value of 99.86% for the Low Risk category

A pooled analysis of multiple studies exclusively using hs-cTn assays containing 4021 patients with a total of 646 events found a sensitivity of 99.23% and a negative predictive value of 99.68% for the combined categories of Low Risk and Fairly Low Risk.

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Underlying models Part of

Additional information

Details

Model author

Evidencio.Medical.Devices

Model ID

10445

Version

2.5

Revision date

2024-05-31

Specialty

Cardiology

Model type

Custom model (Conditional)

MeSH terms

Cardiovascular Disease

Status

Public

Condition	Formula

Study characteristics

Additional information

Several different studies were analyse the ADAPT Algorithm, including the Derivation study as well as several validation studies. Of these, most used hs-cTn assays, except for the derivation study by Than et al.

The following studies were used for the statistics surrounding risk:
Than et al. (2012)^1,3
Cullen et al. (2013)^1,2,4
Than et al. (2016)¹
Chae et al. (2023) ²
Kim et al. (2020) ²

1: Used for the calculation of the Sensitivity and NPV of the low risk category
2: Used for the calculation of the Sensitivity and NPV of the combined low risk and fairly low risk category, High-sensitivity troponin only.
3: Used for the calculation of the risk levels per category with contemporary troponin assays
4: Used for the caluclation of the risk levels per category with high-sensitivity troponin assays.

Study Population

Total population size: 1975

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Continuous characteristics

Name	Mean	SD	Unit
Age	60.4	0	Years
Length of initial hospital attendance (h)	81.8	0	Hour

Categorical characteristics

Name	Subset / Group	Nr. of patients
Hypertension	Yes	1029
Hypertension	No	946
Diabetes	Yes	285
Diabetes	No	1690
Dyslipidemia	Yes	1009
Dyslipidemia	No	966
Previous smoker	Yes	823
Current smoker	Yes	374
Family history of coronary artery disease	yes	1056
Family history of coronary artery disease	No	919
Angina	Yes	668
Angina	No	1307
Coronary artery disease	Yes	415
Coronary artery disease	No	1560
Acute myocardial infarction	Yes	461
Acute myocardial infarction	No	1514
Revascularization	Yes	341
Revascularization	No	1634
Congestive heart failure	Yes	157
Congestive heart failure	No	1818
Stroke	Yes	190
Stroke	No	1785
Coronary artery bypass graft	Yes	172
Coronary artery bypass graft	No	1803
Arrhythmia	Yes	121
Arrhythmia	No	1854

Supporting Publications

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Extra Information

	Evidencio B.V., Irenesingel 19, 7481 GJ Haaksbergen, The Netherlands
	V-2.5-158.24.05.31
	(01)08719327522721(8012)v2.5(4326)240531(240)158
	Decomplix AG, Freiburgstrasse 3, 3010 Bern, Switzerland
	Download the User manual
	Medical device

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This model has been certified as a medical device

V-2.5-158.24.05.31

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30-day risk of MACE is %

Conditional information

Details

Study characteristics

Additional information

Study Population

Continuous characteristics

Categorical characteristics

Supporting Publications

Related files

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This is a paid model

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