Direct Comparison of the 0/1h‐ and 0/2h‐Algorithms in Patients With Prior Coronary Artery Bypass Grafting
Key result
ESC 0/2h hs-cTn algorithm yields ~8% higher MI triage efficacy than 0/1h in prior CABG.
- difference 7.9%
- 95% CI 4.2-11.5
- n=356
Why the study?
ESC 0/1h-hs-cTn algorithms have lower efficacy in patients with prior CABG, leading to the hypothesis that the longer 0/2h-hs-cTn interval would increase triage efficacy.
Does the ESC 0/2h hs-cTn algorithm improve triage efficacy compared to the ESC 0/1h hs-cTn algorithm in patients with prior CABG presenting with acute chest discomfort?
Population
356 patients with prior CABG presenting with acute chest discomfort, plus 178 in validation cohort
Comparison
ESC 0/2h-hs-cTn algorithms vs ESC 0/1h-hs-cTn algorithms
Design
Prospective international multicenter diagnostic study with independent prospective US validation
Authors
Discussion
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Member takes
Implication
May enhance triage efficacy in post-CABG patients; leaves open need for prospective validation before practice change.
Key Points
- To directly compare the safety and triage efficacy of the ESC 0/1-hour and 0/2-hour high-sensitivity cardiac troponin algorithms in patients with prior coronary artery bypass grafting presenting with acute chest discomfort.
- Conducted a prospective international multicenter diagnostic study (NCT00470587) in emergency department patients with acute chest discomfort and prior coronary artery bypass grafting, with central adjudication of final diagnoses per the Universal Definition of Myocardial Infarction.
- Evaluated 356 patients in the primary cohort (median age 73 years) and validated results in an independent prospective US multicenter cohort of 178 patients across different high-sensitivity cardiac troponin assays (hs-cTnT-Elecsys, hs-cTnI-Architect, and hs-cTnI-Atellica).
- For hs-cTnT-Elecsys, sensitivity for NSTEMI rule-out was 100% (95% CI 96.7–100) for 0/1h and 99.1% (95% CI 95.1–99.8) for 0/2h, with rule-in specificity of 97.1% (95% CI 94.2–98.6) and 98.4% (95% CI 95.9–99.4), respectively.
- Triage efficacy was significantly higher with the 0/2-hour protocol than the 0/1-hour protocol (58.4% vs 50.6%; difference: 7.9% [95% CI 4.2–11.5]).
- Superior efficacy for the 0/2-hour algorithm was confirmed with hs-cTnI-Architect (difference: 3.1% [95% CI 0.1–6.1]) and in the external validation cohort with hs-cTnI-Atellica (difference: 9.0% [95% CI 4.5–13.5]).
Study Design
Type
Observational (n=356)
Multicenter
Yes
Structured PICO
Does the ESC 0/2h hs-cTn algorithm improve triage efficacy compared to the ESC 0/1h hs-cTn algorithm in patients with prior CABG presenting with acute chest discomfort?
P
Population
356 patients with prior coronary artery bypass grafting presenting to the emergency department with acute chest discomfort, with an external validation cohort of 178 patients.
E
Exposure
European Society of Cardiology (ESC) 0/2h high-sensitivity cardiac troponin (hs-cTn) algorithm
C
Comparator
European Society of Cardiology (ESC) 0/1h high-sensitivity cardiac troponin (hs-cTn) algorithm
O
Outcome
Efficacy (defined as the proportion of patients triaged to rule-in/out of myocardial infarction) and safety (sensitivity for rule-out and specificity for rule-in)surrogate
Main Result
Effect estimate: difference 7.9% (95% CI 4.2-11.5)
Absolute Event Rate: 58.4% vs 50.6%
In patients with prior CABG presenting with acute chest discomfort, the ESC 0/2h hs-cTn algorithm provides higher triage efficacy with comparable safety compared to the 0/1h algorithm.
Cite This Study
Koechlin et al. (2026) conducted an observational in Acute chest discomfort in patients with prior coronary artery bypass grafting (n=356). ESC 0/2h-hs-cTn-algorithms vs. ESC 0/1h-hs-cTn-algorithms was evaluated on Efficacy, defined as the proportion of patients triaged to rule-in/out of myocardial infarction (difference 7.9%, 95% CI 4.2-11.5). The ESC 0/2h-hs-cTn-algorithms had higher efficacy for triaging myocardial infarction than the 0/1h-algorithms (58.4% vs 50.6%; difference 7.9%, 95% CI 4.2-11.5) in patients with prior CABG.