ESC 0/1-h algorithm safe, effective for early detection of myocardial infarction
A recent study has shown the safety and efficacy of the European Society of Cardiology (ESC) 0/1-h algorithm using high-sensitivity cardiac troponin (hs-cTn) in triaging patients with suspected non–ST-segment elevation myocardial infarction (NSTEMI).
Unselected patients in six countries presenting to the emergency department with symptoms suggestive of NSTEMI were prospectively enrolled. Two independent cardiologists adjudicated the final diagnosis. The authors measured hs-cTnT and hs-cTnI blood concentrations at presentation and after 1 hour.
Safety of rule-out, accuracy of rule-in and overall efficacy were respectively quantified by the negative predictive value (NPV) for NSTEMI, the positive predictive value (PPV), and the proportion of patients triaged towards rule-out or rule-in within 1 hour.
A 17-percent prevalence of NSTEMI was recorded. In 4,368 patients with serial hs-cTnT measurements available, there were high rule-out safety (NPV, 99.8 percent; 2,488 of 2,493), rule-in accuracy (PPV, 74.5 percent; 572 of 768) and overall efficacy by assigning three-fourths of patients either to rule-out (57 percent; 2,493–4,368) or rule-in (18 percent; 768–4,368).
Likewise, safety of rule-out (NPV, 99.7 percent; 1,528 of 1,533), accuracy of rule-in (PPV, 62.3 percent; 498 of 800) and overall efficacy were high among 3,500 patients with serial hs-cTnI measurements by assigning more than two-thirds of patients either to rule-out (44 percent; 1,533 of 3,500) or rule-in (23 percent; 800 of 3,500).
Multiple subgroup analyses, including patients presenting early (≤3 hours) after chest pain onset, confirmed excellent safety, according to the authors.