Key result
The ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin showed high diagnostic accuracy for acute myocardial infarction, with a pooled sensitivity of 99% (95% CI 98-99%) and specificity of 91%.
Why the study?
The ESC recommends a rapid 0-hour/1-hour hs-cTn algorithm for rule-out or rule-in of AMI, and multiple recent studies had validated it in their respective settings.
Does the ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin accurately diagnose acute myocardial infarction in adults presenting to the emergency department with possible acute coronary syndrome?
Meta-Analysis (n=19,213)
Yes
Does the ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin accurately diagnose acute myocardial infarction in adults presenting to the emergency department with possible acute coronary syndrome?
Effect estimate: Sensitivity 99% (95% CI 98-99)
The ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin provides high diagnostic accuracy, allowing safe rule-out and accurate rule-in of AMI.
Supports rapid AMI rule-out and rule-in in the ED; confirms algorithm reliability across studies.
INTRODUCTION: A rapid rule-out or rule-in protocol based on the 0-hour/1-hour algorithm using high-sensitivity cardiac troponin (hs-cTn) is recommended by the European Society of Cardiology (ESC); recently multiple studies have validated it in their settings. We aimed to assess the diagnostic accuracy of the 2015 ESC guidelines for management of acute coronary syndrome in patients without ST-segment elevation 0-hour/1-hour algorithm using hs-cTn for the early rule-out and rule-in of acute myocardial infarction (AMI) on presentation. METHODS: Systematic searches were conducted using PubMed, the Cochrane Library and the International Clinical Trials Registry Platform to identify prospective studies from 2015 to October 2019 involving adults presenting to the emergency department with possible acute coronary syndrome in which hs-cTn measurements were obtained according to the ESC algorithm and AMI outcomes were adjudicated during the initial hospitalization. RESULTS: Eleven studies, involving 19,213 patients, were identified. Pooled prevalence of AMI during the index hospitalization was 11.3% (95% confidence interval (CI) 3.9-18.8%). Summary sensitivity and specificity in diagnosing AMI were 99% (95% CI 98-99%; I2 63%) and 91% (95% CI 91-92%; I2 96%) respectively. The summary positive likelihood ratio was 11.6 (95% CI 8.5-15.8; I2 97%) and the pooled likelihood ratio negative 0.02 (0.01-0.03; I2 52%). Cumulative all-cause mortality at 30 days in the rule-out group was 0.11%, and 2.8% in the rule-in group, and 30 days AMI in the rule-out group was 0.08%. CONCLUSION: The ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin has high diagnostic accuracy; it allows safe rule-out as well as accurate rule-in of AMI, with low cumulative 30-day mortality and AMI in patients assigned the rule-out zone.
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Burgos et al. (2020) conducted a meta-analysis in possible acute coronary syndrome (n=19,213). ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin was evaluated on Diagnosis of acute myocardial infarction (Sensitivity 99%, 95% CI 98-99). The ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin showed high diagnostic accuracy for acute myocardial infarction, with a pooled sensitivity of 99% (95% CI 98-99%) and specificity of 91%.
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