The 0/1/3h hs-cTnT algorithm demonstrated excellent rule-out safety (NPV 99.7%), while delayed rule-out at 3h doubled MACE risk (HR 2.11; 95% CI 1.44-3.08) compared to immediate rule-out.
Cohort (n=2,514)
Does the 0/1/3h hs-cTnT algorithm accurately diagnose myocardial infarction and predict long-term cardiovascular events in patients with suspected MI?
The 0/1/3h hs-cTnT algorithm safely rules out myocardial infarction and identifies patients requiring delayed rule-out who are at significantly higher long-term risk for MACE and mortality.
Effect estimate: HR 2.11 (95% CI 1.44-3.08)
p-value: p=<0.001
Abstract Background The European Society of Cardiology (ESC) recommends 0/1h-algorithms for triage of patients with suspected myocardial infarction (MI). Recently, cut-offs allowing 3h triage using high-sensitivity cardiac troponin T (hs-cTnT) have been derived, but their prognostic implications remain unclear, and external validation is lacking. Objective To externally validate the diagnostic performance and assess the prognostic impact of the 0/1/3h algorithm for cardiovascular events in an all-comer cohort with suspected MI. Methods We prospectively enrolled patients presenting to the emergency department with suspected MI. hs-cTnT was measured at presentation, 1h, and 3h. Patients were followed up to evaluate all-cause mortality and major adverse cardiovascular events (MACE). Diagnostic accuracy was assessed by stratifying patients using the 0/1/3h algorithm. Cox regression analyses compared cardiovascular risk at 90 days and three years between rule-in and rule-out groups. Results Among 2,514 patients (median age 64 years; 63.6% men), the algorithm demonstrated excellent rule-out safety (sensitivity 98.6% 95% CI, 96.8, 99.4; NPV 99.7% 99.2, 99.9) and moderate rule-in capacity (specificity 89.3% 87.9, 90.5; PPV 60.8% 56.8, 64.7). Over three years, 646 patients experienced MACE, and 256 died (68 cardiac deaths). Patients ruled-out at 3h had doubled MACE risk (HR 2.11 1.44, 3.08) and quadrupled mortality risk (HR 4.33 1.85, 10.12) compared to immediate rule-out (p0.001). Conclusion The 0/1/3h algorithm shows excellent diagnostic safety and adds prognostic value, with delayed rule-out associated with significantly increased long-term cardiovascular risk and mortality.
Lehmacher et al. (Sun,) conducted a cohort in suspected myocardial infarction (n=2,514). 0/1/3h algorithm using hs-cTnT vs. immediate rule-out was evaluated on MACE at three years (delayed rule-out at 3h vs immediate rule-out) (HR 2.11, 95% CI 1.44-3.08, p=<0.001). The 0/1/3h hs-cTnT algorithm demonstrated excellent rule-out safety (NPV 99.7%), while delayed rule-out at 3h doubled MACE risk (HR 2.11; 95% CI 1.44-3.08) compared to immediate rule-out.