Accelerated diagnostic protocols such as the ESC 0/1 h pathway demonstrate strong rule-out performance for suspected myocardial infarction, but real-world implementation studies are still required.
How do different accelerated diagnostic protocols using high-sensitivity cardiac troponins compare in assessing acute chest pain patients for suspected myocardial infarction?
The ESC 0/1 h and high-STEACS accelerated diagnostic protocols offer superior rule-out safety for suspected myocardial infarction compared to the ESC 0/3 h protocol, though real-world comparative studies are needed.
There have been considerable developments in the analytic precision of cardiac troponins in the last three decades. Whilst there has been near-universal uptake of this technology, there is considerable variability in how to assess acute chest pain patients using high-sensitivity cardiac troponins. This review describes the historical narrative for cardiac troponins and details the evidence base behind decision rules, such as single sample rule-out, single sample rule-in, and accelerated diagnostic protocols (ADPs). There is particular focus on the European Society of Cardiology (ESC) 0/1 and 0/3 h and the high-STEACS ADPs. The ESC 0/3 h ADP appears to have reduced rule-out safety compared to both the ESC 0/1 h and high-STEACS ADP. However, whilst high-STEACS performed well in its validation population, external validation in the US has been less impressive and warrants further investigation. The ESC 0/1 h pathway has demonstrated strong rule-out performance, helped by its observational zone. However, real world implementation studies comparing these ADPs are required to understand their impact on Emergency Department efficiency and the safety of clinician decision-making.
Hatherley等人（星期三）对疑似心肌梗死进行了综述。评估了加速诊断协议（ADPs）。诸如ESC 0/1小时通路等加速诊断协议在排除疑似心肌梗死方面表现出强大的效能，但仍需要现实世界的实施研究。