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Acute Chest Pain Treatment and Evaluation (ACTION) Study

This study has been completed.
ClinicalTrials.gov Identifier:
First Posted: February 13, 2007
Last Update Posted: February 10, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
National Medical Research Council (NMRC), Singapore
National Heart Centre Singapore
Information provided by (Responsible Party):
Singapore General Hospital


  1. To compare the incidence of adverse cardiac events among the patients discharged after evaluation through ACTION protocol with those through conventional protocol. The adverse cardiac events for the follow-up are defined as any of the followings:

    • Cardiac related death
    • Ventricular fibrillation
    • Myocardial infarction
    • Cardiogenic shock requiring the inta-aortic balloon pump circulatory assistance
    • Acute pulmonary oedema requiring endo-tracheal intubation
  2. To study the sensitivity / predictive values of the various components of ACTION :12 lead ECG ST monitoring , serial serum markers for myocardial necrosis (myoglobin, CKMB, TnT, graded exercise testing, stress tetrofosmin scan/ stress echocardiography) in predicting adverse cardiac events.

Design -prospective randomised clinical trial


-patients above 25 years of age presenting to the ED with chest pain consistent with myocardial ischaemia but with a 12 lead ECG non-diagnostic of myocardial ischaemia .


Patients were monitored continuously with a 12 lead ECG and ST segment trend monitoring and blood will be drawn at 0,3,6 hours after arrival at ED for serial myoglobin, creatine kinase MB isoenzyme (CKMB) and Troponin T (TnT) . Patients who have ECG and blood test consistent with myocardial necrosis were admitted to the CCU. A senior doctor in the ED reviewed patients who were not admitted after 6 hours of observation.

Study Group

A stress tetrofosmin nuclear scan was done . Patients were then admitted and discharged depending on the results of the stress tetrofosmin scan.

Control group (conventional protocol)

Patients were then be admitted or discharged at the discretion of the senior ED doctor.

Measurement Patients were followed up at 1 week , 2 weeks , one month and six months for any adverse cardiac events such as cardiac related death , ventricular fibrillation , and myocardial infarction.

Statistical analysis Logistic regression analysis were used to compare the proportion of adverse events in the two treatment groups.

Condition Intervention Phase
Chest Pain Procedure: Stress nuclear scan Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomised Trial on Early Stress Nuclear Scan for Patients Presented to the Emergency Department (ED) With Chest Pain But Non-diagnostic Electrocardiography-Acute Chest Pain Treatment and Evaluation (ACTION) Study

Resource links provided by NLM:

Further study details as provided by Singapore General Hospital:

Primary Outcome Measures:
  • Cardiac related death
  • Ventricular Fibrillation
  • Myocardial Infarction
  • Cardiogenic shock requiring intra-aortic balloon pump circulatory assistance
  • Acute pulmonary oedema requiring endotracheal intubation

Secondary Outcome Measures:
  • Requirement of emergency coronary revascularisation procedures like Percutaneous Transluminal Coronary Angioplasty (PTCA) or Coronary Artery Bypass Graft (CABG)

Estimated Enrollment: 1690
Study Start Date: August 2000
Estimated Study Completion Date: May 2002
  Show Detailed Description


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Ages Eligible for Study:   25 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 25 years and above
  • Chest pain suggestive of the angina
  • 12 leads ECG non-diagnostic for myocardial ischaemia or AMI
  • diabetes mellitus
  • family history of young AMI (less than 50 years old) There is no lower limit of age for those patients in the last two categories

Exclusion Criteria:

  • ECG diagnostic of AMI or acute myocardial ischaemia (as defined by the new Q wave , ST elevation or depression greater than 1mm or 0.1 millivolts in two or more contiguous leads)
  • Congestive heart failure or hypotensive patients
  • Persistent chest pain consistent with unstable angina
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00434564

Singapore General Hospital
Singapore, Singapore
Sponsors and Collaborators
Singapore General Hospital
National Medical Research Council (NMRC), Singapore
National Heart Centre Singapore
Principal Investigator: Lim S Han, MBBS, FRCS Department of Emergency Medicine, Singapore General Hospital
  More Information

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McCarthy BD, Beshansky JR, D'Agostino RB, Selker HP. Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med. 1993 Mar;22(3):579-82.
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Gibler WB, Lewis LM, Erb RE, Makens PK, Kaplan BC, Vaughn RH, Biagini AV, Blanton JD, Campbell WB. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg Med. 1990 Dec;19(12):1359-66. Erratum in: Ann Emerg Med 1991 Apr;20(4):420.
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Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989 Jul;80(1):87-98. Review.
Sawada SG, Ryan T, Conley MJ, Corya BC, Feigenbaum H, Armstrong WF. Prognostic value of a normal exercise echocardiogram. Am Heart J. 1990 Jul;120(1):49-55.
Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD, Concannon CA, Cowan M, Edwards C, Fuster V, et al. Diagnosing and managing unstable angina. Agency for Health Care Policy and Research. Circulation. 1994 Jul;90(1):613-22.

Responsible Party: Singapore General Hospital
ClinicalTrials.gov Identifier: NCT00434564     History of Changes
Other Study ID Numbers: NMRC/0517/2001
First Submitted: February 12, 2007
First Posted: February 13, 2007
Last Update Posted: February 10, 2017
Last Verified: February 2017

Keywords provided by Singapore General Hospital:
Stress nuclear scan
Acute chest pain

Additional relevant MeSH terms:
Chest Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms

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