Routine clinical use of the ESC 0/1-hour algorithm triaged 62% of patients toward rule-out, with a 30-day MACE rate of 0.2% (95% CI 0.03%-0.5%) in the rule-out group.
Observational (n=2,296)
Yes
BACKGROUND The European Society of Cardiology (ESC) recommends the 0/1-h algorithm for rapid triage of patients with suspected non-ST-segment elevation myocardial infarction (MI). However, its impact on patient management and safety when routinely applied is unknown. OBJECTIVES This study sought to determine these important real-world outcome data. METHODS In a prospective international study enrolling patients presenting with acute chest discomfort to the emergency department (ED), the authors assessed the real-world performance of the ESC 0/1-h algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care and its associated 30-day rates of major adverse cardiac events (MACE) (the composite of cardiovascular death and MI). RESULTS Among 2,296 patients, non-ST-segment elevation MI prevalence was 9.8%. In median, 1-h blood samples were collected 65 min after the 0-h blood draw. Overall, 94% of patients were managed without protocol violations, and 98% of patients triaged toward rule-out did not require additional cardiac investigations including high-sensitivity cardiac troponin T measurements at later time points or coronary computed tomography angiography in the ED. Median ED stay was 2 h and 30 min. The ESC 0/1-h algorithm triaged 62% of patients toward rule-out, and 71% of all patients underwent outpatient management. Proportion of patients with 30-day MACE were 0.2% (95% confidence interval: 03% to 0.5%) in the rule-out group and 0.1% (95% confidence interval: 0% to 0.2%) in outpatients. Very low MACE rates were confirmed in multiple subgroups, including early presenters. CONCLUSIONS These real-world data document the excellent applicability, short time to ED discharge, and low rate of 30-day MACE associated with the routine clinical use of the ESC 0/1-h algorithm for the management of patients presenting with acute chest discomfort to the ED.
“It's a frequent scenario that patients present with symptoms suggestive of myocardial infarction. Applying this algorithm substantially speeds up and facilitates the management of these patients, which is good for the patients because the time they have to wait with the uncertainty and the anxiety until they get exclusion of myocardial infarction or the assignment to high risk is reduced.”
Twerenbold et al. (Mon,) conducted a observational in Suspected non-ST-segment elevation myocardial infarction (n=2,296). ESC 0/1-hour algorithm using high-sensitivity cardiac troponin T was evaluated on 30-day major adverse cardiac events (MACE) (composite of cardiovascular death and MI) (95% CI 0.03%-0.5%). Routine clinical use of the ESC 0/1-hour algorithm triaged 62% of patients toward rule-out, with a 30-day MACE rate of 0.2% (95% CI 0.03%-0.5%) in the rule-out group.