Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction - Twerenbold, R.; Costabel, J. P.; Nestelberger, T.; Campos, R.; Wussler, D.; Arbucci, R.; Cortes, M.; Boeddinghaus, J.; Baumgartner, B.; Nickel, C. H.; Bingisser, R.; Badertscher, P.; et al. (J Am Coll Cardiol, 2019)
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.
Keywords: journalArticle; *Algorithms; *Guideline Adherence; 0/1-h algorithm; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction/*diagnosis; Outcome Assessment, Health Care; Prospective Studies; Time Factors; Triage/standards; acute myocardial infarction; high-sensitivity cardiac troponin; outcome; rule-out; safety