The ESC 0/1h-algorithm had higher sensitivity (100% vs 98.1%, P<0.001) but ruled out fewer patients (52% vs 72.5%) compared with the High-STEACS 0/2h-pathway using hs-cTnI-Architect.
Observational (n=4,663)
Yes
Does the ESC 0/1h-algorithm improve diagnostic performance for NSTEMI compared to the High-STEACS 0/2h-0/3h-pathway in patients presenting with acute chest discomfort?
Both the ESC 0/1h and High-STEACS 0/2h-0/3h algorithms show excellent performance for rapid NSTEMI diagnosis, with ESC 0/1h offering higher sensitivity and specificity, while High-STEACS provides higher efficacy in ruling out patients.
Absolute Event Rate: 100% vs 98.1%
p-value: p=<0.001
The optimal approach for the early diagnosis of non–ST-segment elevation myocardial infarction (NSTEMI) remains uncertain, because no large trials have been performed. Accordingly, guideline recommendations differ and do not overall give a clear answer. The authors aimed to directly compare the European Society of Cardiology 0/1-hour algorithm (ESC 0/1h-algorithm) and the high-sensitivity troponin in the evaluation of patients with acute coronary syndrome 0/2-hour or 0/3-hour pathway (High-STEACS 0/2h-0/3h-pathway) in patients presenting with acute chest discomfort. This prospective, international, multicenter, diagnostic study enrolled patients presenting to the emergency department with acute chest discomfort. Final diagnoses were centrally adjudicated by 2 independent cardiologists. The primary diagnostic endpoint was NSTEMI type 1. Both algorithms were applied in parallel using 3 high-sensitivity cardiac troponin (hs-cTn) assays: hs-cTnI-Architect, hs-cTnI-Centaur/Atellica, and hs-cTnT-Elecsys. The findings were externally validated in an independent prospective diagnostic study. Among 4,663 eligible patients (median age: 61 years; 32% women), 663 (14.2%) had NSTEMI type 1. The ESC 0/1h-algorithm had higher sensitivity when using hs-cTnI-Architect (100% 95% CI: 99.4-100) compared with the High-STEACS 0/2h-pathway (98.1% 95% CI: 96.7-99, P < 0.001), but the proportion of patients assigned to the rule-out group was lower (52% vs 72.5%, P < 0.001). Differences were similar but were less pronounced for hs-cTnI-Centaur/Atellica and absent for hs-cTnT-Elecsys. Specificity was consistently higher for the ESC 0/1h-algorithms vs the High-STEACS 0/2h-0/3h-pathways for all hs-cTnT/I-assays. These findings were confirmed when using High-STEACS 0/3h-pathways and in the external validation cohort (n = 2,485; median age: 64 years; 37% women). Overall, both algorithms exhibited comparable and excellent performance. When using hs-cTnI, the ESC-0/1h-algorithms showed higher sensitivity, whereas the High-STEACS 0/2h-0/3h-pathways demonstrated higher efficacy. Consistently, the ESC 0/1h-algorithms showed higher specificity for NSTEMI. These findings provide direct, validated evidence to guide hospitals in selecting an hs-cTn pathway aligned with their clinical and operational priorities. (Advantageous Predictors of Acute Coronary Syndromes Evaluation APACE Study APACE, NCT00470587 ; Biomarkers in Acute Cardiac Care BACC, NCT02355457 )
Glaeser et al. (2026) conducted an observational in Suspected Acute Coronary Syndrome (n=4,663). ESC 0/1h-algorithm vs. High-STEACS 0/2h-0/3h-pathway was evaluated on NSTEMI type 1 (p=<0.001). The ESC 0/1h-algorithm had higher sensitivity (100% vs 98.1%, P<0.001) but ruled out fewer patients (52% vs 72.5%) compared with the High-STEACS 0/2h-pathway using hs-cTnI-Architect.