What question did this study set out to answer?

To describe the design of the PRESC1SE-MI trial assessing the safety and efficacy of implementing the rapid ESC 0/1h-algorithm compared to the standard ESC 0/3h-algorithm for emergency department triage.

October 31, 2025American Heart JournalOpen Access

PRospective evaluation of the European Society of Cardiology 0/1h-algorithm`s safety and efficacy for triage of patients with suspected myocardial infarction (PRESC1SE-MI): Rationale and design of a prospective international multicenter stepped-wedge cluster randomized controlled trial

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Why the study?

Many centers have not adopted the recommended ESC 0/1h-algorithm for suspected MI due to uncertainty over whether it or the ESC 0/3h-algorithm best balances safety and efficacy.

Does the ESC 0/1h-algorithm improve efficacy (length of stay) without compromising safety (type 1 MI or death at 30 days) compared to the ESC 0/3h-algorithm in adult patients with suspected MI?

Key Points

To describe the design of the PRESC1SE-MI trial assessing the safety and efficacy of implementing the rapid ESC 0/1h-algorithm compared to the standard ESC 0/3h-algorithm for emergency department triage.
International, investigator-initiated, multicenter, stepped-wedge cluster randomized controlled trial (NCT05649384) enrolling at least 52,156 adult patients with suspected myocardial infarction presenting with acute chest discomfort.
Participating emergency department sites currently using the ESC 0/3h-algorithm are randomized to transition to the rapid ESC 0/1h-algorithm at early or late implementation steps.
The study is powered at ≥90% to demonstrate noninferiority for safety, measured by a composite of type 1 myocardial infarction or all-cause mortality at 30 days.
Superiority will be evaluated for efficacy, defined by total length of stay in the emergency department.

Structured PICO

Does the ESC 0/1h-algorithm improve efficacy (length of stay) without compromising safety (type 1 MI or death at 30 days) compared to the ESC 0/3h-algorithm in adult patients with suspected MI?

Population

At least 52,156 consecutive adult patients with nontraumatic acute chest discomfort and suspected MI presenting to the Emergency Department (ED)

Intervention

ESC 0/1h-algorithm for triage

Comparator

ESC 0/3h-algorithm as standard-of-care

Outcome

Co-primary outcomes: composite of type 1 MI or all-cause death at 30 days (safety), and the length of stay in the ED (efficacy)composite

This rationale and design paper outlines a large-scale cluster randomized trial to evaluate the safety and efficacy of the ESC 0/1h-algorithm versus the 0/3h-algorithm for triage of suspected MI.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Do not adopt the ESC 0/1h-algorithm yet; leaves open its safety and efficacy versus the 0/3h-algorithm in late-adopting centers.

Cite This Study

Boeddinghaus et al. (2025) studied this question.

synapsesocial.com/papers/6a7fca57e62c735d110fe43b https://doi.org/10.1016/j.ahj.2025.107299

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PRospective evaluation of the European Society of Cardiology 0/1h-algorithm`s safety and efficacy for triage of patients with suspected myocardial infarction (PRESC1SE-MI): Rationale and design of a prospective international multicenter stepped-wedge cluster randomized controlled trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

PRospective evaluation of the European Society of Cardiology 0/1h-algorithm`s safety and efficacy for triage of patients with suspected myocardial infarction (PRESC1SE-MI): Rationale and design of a prospective international multicenter stepped-wedge cluster randomized controlled trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider