Implementing the European Society of Cardiology 0-h/1-h algorithm in patients presenting very early after chest pain

Shiozaki, Masayuki; Inoue, Kenji; Suwa, Satoru; Lee, Chien‐Chang; Chiang, Shuo-Ju; Sato, Akihiro; Shimizu, Megumi; Fukuda, Kentaro; Hiki, Masaru; Kubota, Naozumi; Tamura, Hiroshi; Fujiwara, Yoshihiro; Ouchi, Shohei; Miyazaki, Tatsuya; Hirano, Yohei; Tanaka, Hiroshi; Sugita, Manabu; Nakazato, Yuji; Sumiyoshi, Masataka; Daida, Hiroyuki

doi:10.1016/j.ijcard.2020.07.037

Cited by 9 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Shiozaki el al. reported Japan-Taiwan data [ 18 , 26 , 32 ]; however, particularly patients from Asian and African countries are largely underrepresented in the existing validation cohorts. As a result, the 0/1-h algorithm has not been introduced at some institutions in regular clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Regional differences in the management of NSTE-ACS persist in Asian countries even after extensive adjustment for baseline characteristics and treatment [ 12 ]. Indeed, in previous studies, the MACE rates tend to be higher than in Central European or North American countries and vary from 1 to 4% [ 10 , 18 , 22 , 23 ]. We estimated that, in the standard care arm, patients managed as outpatients by usual care would experience an event rate of 3%, for the primary outcome of MACE including all-cause death, subsequent myocardial infarction, unstable angina, or unexpected revascularization in 30 days.…”

Section: Methodsmentioning

confidence: 99%

“…Limit of blank and limit of detection have been determined to be 3 and 5 ng/L. The physicians will complete the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the ED Assessment of Chest pain Score (EDACS) [15][16][17], and the HEART score will be further modified using the hs-cTnT level [18].…”

Section: Routine Clinical Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

Inoue

Chieh

Yeh

et al. 2022

Trials

Self Cite

View full text Add to dashboard Cite

Background More than half of the world’s population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data. Methods The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply “usual care” according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED. Conclusions This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Routine Clinical Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

Inoue

Chieh

Yeh

et al. 2022

Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…Unstable angina was diagnosed in patients with normal hs-cTnT levels both on admission and 1-h follow-up in case of cardiac catheterization with severe stenotic lesion (>70% stenosis) or clear appearance of thrombus in the culprit lesion in the coronary artery [4]. Atypical chest pain was diagnosed on the basis of the absence of findings from laboratory tests, electrocardiography, and chest radiography at the 30-day follow-up [9, 10].…”

Section: Methodsmentioning

confidence: 99%

Clinical Evaluation of a New High-Sensitivity Cardiac Troponin I Assay for Diagnosis and Risk Assessment of Patients with Suspected Acute Myocardial Infarction

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction: Current assays based on the 0-hour/1-hour (0-/1-h) algorithm using high-sensitivity cardiac troponin (hs-cTn) are limited to only Abbott Architect hs-cTnI, Siemens Vista hs-cTnI, and Roche Elecsys hs-cTnT. Objective: This study aimed to evaluate this new hs-cTnI assay, LumipulsePresto hs Troponin I, for diagnosis of acute myocardial infarction (AMI) on admission and on 0-/1-h algorithm to stratify AMI patients precisely. Methods: This prospective cohort study included 442 patients with suspected non-ST-elevation myocardial infarction in three hospitals in Japan and Taiwan from June 2016 to January 2019. We enrolled patients presenting to the emergency department with symptoms suggestive of AMI and collected blood samples on admission and 1 hour later. Two independent cardiologists centrally adjudicated final diagnoses; all clinical information was reviewed twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis) and Lumipulse Presto Lumipulse Presto, second, using the Lumipulse Presto hs-cTnI measurements. At first, we compared diagnostic accuracy quantified using receiver operating characteristic (ROC) curves for AMI. Then, we evaluated major adverse cardiovascular events (cardiac death, AMI) in the rule-out group according to a 0-hour/1-hour algorithm at the 30-day follow-up. Results: Diagnostic accuracy at presentation by the ROC curve for AMI was very high and similar for the LumipulsePresto hs-cTnI and hs-cTnT,(area under the curve [AUC]: LumipulsePresto hs-cTnI, 0.89, 95% confidence interval [CI] 0.86–0.93; hs-cTnT, 0.89, 95% CI 0.85–0.93; p = 0.82). In early presenters, the LumipulsePresto hs-cTnI appeared to maintain the diagnostic performance of hs-cTn for patients with <3 h (AUC: LumipulsePresto hs-cTnI, 0.87, 95% CI 0.81–0.92; hs-cTnT, 0.86, 95% CI 0.80–0.92; p = 0.81). The algorithm using the LumipulsePresto hs-cTnI ruled out AMI in 200 patients with negative predictive value and sensitivity of 100% (95% CI 97.3%–100%) and 100% (95% CI 92.7%–100%), respectively, in the rule-out group. Conclusion: Diagnostic accuracy and clinical utility of the novel LumipulsePresto hs-cTnI assay are high and comparable with the established hs-cTn assays.

show abstract

“…3,4 Shiozaki et al examined the APSC and ESC algorithms performances in a prospective study of the ESC 0-hour/1-hour algorithm in Japan and Taiwan. 6,7 Using the cohort data, 903 patients with a prevalence rate of acute MI of 13.1%, the utility of the ESC 0-hour/1-hour algorithm and the APSC algorithm were compared. Major adverse cardiovascular events consisted of all-cause mortality, subsequent acute MI and unexpected coronary revascularisation in 30 days.…”

mentioning

confidence: 99%

High-sensitivity Troponins in the Emergency Department: Which Guideline to Recommend in Asia?

AbdelWareth¹

2022

J Asian Pac Soc Cardiol

View full text Add to dashboard Cite

show abstract

Implementing the European Society of Cardiology 0-h/1-h algorithm in patients presenting very early after chest pain

Cited by 9 publications

References 24 publications

An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

Clinical Evaluation of a New High-Sensitivity Cardiac Troponin I Assay for Diagnosis and Risk Assessment of Patients with Suspected Acute Myocardial Infarction

High-sensitivity Troponins in the Emergency Department: Which Guideline to Recommend in Asia?

Contact Info

Product

Resources

About