- For emergency department (ED) patients with suspected non-ST-segment elevation myocardial infarction (NSTE[MI]), routine use of the European Society of Cardiology (ESC) 0/1-hour triage algorithm with high-sensitivity cardiac troponin T (hs-cTnT) is feasible, fast, and accurate.
- “Such impressive prospective safety and effectiveness data favor broader dissemination.”
- “Further refinements (of existing accelerated diagnostic protocols) will be on the margin, at best.”
Why this matters
- The 0/1-hour algorithm compares hs-cTnT at presentation and 1 hour later to rule NSTEMI in or out.
- Though it is supported by evidence, real-world questions remained.
- NSTEMI prevalence: 9.8%.
- Median time between blood draws: 65 minutes.
- Protocol violations occurred in 6%.
- Median time in ED: 2 hours 30 minutes.
- 62% ruled out:
- Major adverse cardiac event (MACE) rate: 0.2% (95% CI, 0.0%-0.5%).
- MI within 30 days: 0.1% (95% CI, 0%-0.4%).
- 71% managed as outpatients: MACE rate, 0.1% (95% CI, 0.0%-0.2%).
- Missed MI rate: 0%.
- Prospective 2-center study of 0/1-hour rule in 2296 ED patients with symptoms suspicious for MI.
- Outcomes: algorithm performance; 30-day MACE (cardiovascular death, MI).
- Funding: Multiple industry, European governmental, and nonprofit funders.
- Many eligible patients not enrolled.
- Only 36% women.
- High-sensitivity troponin I not assessed.
- No data on racial or ethnic subgroups.