Prospective Validation of EDACS-ADP for 30-Day MACE in Patients with Chest Pain.

OBJECTIVE: To validate the Emergency Department Assessment of Chest Pain Score-Accelerated Diagnostic Pathway (EDACS-ADP) for predicting 30-day major adverse cardiac events (MACE) in patients with chest pain. STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Emergency, Alsancak Nevvar-Salih Isgoren State Hospital, Izmir, Turkiye, from July to November 2025. METHODOLOGY: Adult patients with chest pain were prospectively evaluated using the EDACS-ADP. The predictive ability of EDACS-ADP for 30-day MACE was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value (NPV), likelihood ratios, and by receiver operating characteristic curve analysis with area under the curve estimation. RESULTS: Of the 1,389 screened patients, 773 completed the 30-day follow-up period. The mean age was 45.3 ± 16.1 years, and 55.1% were male. MACE occurred in 49 patients (6.3%), including 32 patients with myocardial infarction and three patients with cardiac death. Using the EDACS-ADP, 608 patients (78.7%) were classified as low-risk, accounting for 6 (12.2%) of all 30-day MACE events. In contrast, 165 patients (21.3%) were classified as at risk, accounting for 43 (87.8%) MACE events (p = 0.001). The diagnostic performance of EDACS-ADP was significantly superior to that of EDACS alone, with a sensitivity of 87.8% versus 34.7% and an NPV of 99.0% versus 95.3%. The relative risk of MACE for at-risk patients was 5.2, with an odds ratio of 35.3. CONCLUSION: EDACS-ADP showed a high diagnostic accuracy and excellent NPV for detecting low-risk patients with chest pain in the emergency department, confirming its usefulness in secondary care settings in Turkiye. KEY WORDS: Chest pain, Emergency department, Acute coronary syndrome, Accelerated diagnostic pathway, Major adverse cardiac events, Risk stratification.