• The ADAPT (2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker) trial was a prospective observational validation study designed to assess a predefined ADP (Accelerated Diagnostic Protocol)
• A low risk patient in this ADP was defined by TIMI 0, ECG w/no ischemic changes, and negative troponin at 0-and 2-hours after presentation
• Primary endpoint was assessment of any major adverse cardiac event (MACE)
• Of 1,975 patients enrolled, 302 (15.3%) had a MACE
• ADP classified 392 patients (20%) as low risk and only 1 (0.25%) had a MACE
• ADP had a sen 99.7%, NPV 99.7%, spec 23.4%, and PPV 19.0%
• Despite ADP identifying patients as low risk for MACE standard of care still requires rapid early outpatient follow-up or further inpatient testing 

References

Than M, Cullen L. 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker. J Am Coll Cardiol. 2012;59(23):2091-2098