ADAPT Cardiac Event Risk

ADAPT Protocol Cardiac Event Risk Calculator

Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Symptoms using 0- and 2-hour troponins, ECG, and modified TIMI score.

Clinical safety note: This tool is for clinical decision support and education only. It does not replace local ACS/chest pain pathways, clinician judgement, serial ECG interpretation, assay-specific troponin guidance, or emergency care. A concerning presentation should be managed urgently.

1) Modified TIMI Score Criteria

ADAPT low-risk classification requires modified TIMI score = 0.

Age ≥ 65 years ≥ 3 CAD risk factors: family history, hypertension, hypercholesterolemia, diabetes, or current smoking Aspirin use in the past 7 days Known significant coronary stenosis, e.g. prior stenosis ≥ 50% Severe angina: ≥ 2 angina episodes in 24 hours or persisting discomfort ST-segment deviation ≥ 0.05 mV on first ECG Initial troponin above the assay cut-off / 99th percentile

Modified TIMI score: 0 / 7

2) ECG and Troponin Assessment

New ischemic ECG changes? Troponin assay upper reference limit / 99th percentile Use your institution’s assay-specific unit and cut-off. 0-hour troponin 2-hour troponin

3) Safety Modifiers

In the implementation pathway, return of pain or abnormal vital signs meant the patient was considered not low risk.

Recurrent / returned chest pain during assessment? Abnormal vital signs or clinician concern?

Interpretation

ADAPT low risk: modified TIMI score 0, no new ischemic ECG changes, and negative 0- and 2-hour troponins.
Not ADAPT low risk: any TIMI criterion present, ischemic ECG change, positive troponin, recurrent pain, abnormal vital signs, or missing required data.
The original ADAPT study reported a very low short-term adverse-event rate among ADP-negative patients, but this should be applied only within a validated local pathway.

References

Than M, Cullen L, Aldous S, et al. 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker: The ADAPT Trial. Journal of the American College of Cardiology. 2012;59(23):2091-2098. https://doi.org/10.1016/j.jacc.2012.02.035
Than M, Aldous S, Lord SJ, et al. A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency Department: A Randomized Clinical Trial. JAMA Internal Medicine. 2014;174(1):51-58. https://doi.org/10.1001/jamainternmed.2013.11362
Mahler SA, Riley RF, Hiestand BC, et al. Performance of the 2-hour Accelerated Diagnostic Protocol Within the American College of Radiology Imaging Network PA 4005 Cohort. Academic Emergency Medicine. 2015.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021.
Writing Committee. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department. Journal of the American College of Cardiology. 2022.