Key result
ESC 0/1-hour hs-cTnT algorithm safely rules out NSTEMI with 100% negative predictive value.
Why the study?
The ESC 0/1-hour algorithm with hs-cTnT has demonstrated high diagnostic performance internationally, but its diagnostic accuracy needed evaluation in a high-volume ED setting in Türkiye.
Does the ESC 0/1-hour algorithm accurately diagnose NSTEMI in adults presenting with acute chest discomfort?
Cohort (n=3,216)
No
Does the ESC 0/1-hour algorithm accurately diagnose NSTEMI in adults presenting with acute chest discomfort?
Effect estimate: NPV 100.0% (95% CI 99.78-100.0)
The ESC 0/1-hour algorithm using hs-cTnT demonstrates excellent sensitivity and 100% NPV for ruling out NSTEMI in a real-world, high-volume emergency department setting.
May support early NSTEMI rule-out with ESC 0/1h hs-cTnT algorithm in Turkish EDs; leaves open need for prospective validation.
BACKGROUND: The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye. METHODS: This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days. RESULTS: Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as "rule-out," 31.3% as "observe," and 12.3% as "rule-in." The sensitivity and negative predictive value (NPV) for NSTEMI in the "rule-out" group were both 100%. In the "rule-in" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the "rule-out" group, 13.9% in the "observe" group, and 67.0% in the "rule-in" group. CONCLUSIONS: The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes. CLINICAL TRIAL NUMBER: Not applicable.
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Kudu et al. (2025) conducted a cohort in Suspected non-ST-segment elevation myocardial infarction (NSTEMI) (n=3,216). ESC 0/1-hour algorithm (hs-cTnT) was evaluated on NSTEMI diagnosis (Negative Predictive Value for rule-out group) (NPV 100.0%, 95% CI 99.78-100.0). The ESC 0/1-hour algorithm using high-sensitivity cardiac troponin T safely ruled out NSTEMI with a negative predictive value of 100% and sensitivity of 100% in a high-volume emergency department.
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