Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction

Twerenbold, Raphael; Costabel, Juan Pablo; Nestelberger, Thomas; Campos, Roberto; Wussler, Desiree; Arbucci, Rosina; Cortés, Marcia; Boeddinghaus, Jasper; Baumgartner, Benjamin; Nickel, Christian H.; Bingisser, Roland; Badertscher, Patrick; Puelacher, Christian; Lavallaz, Jeanne du Fay de; Wildi, Karin; Giménez, María Rubini; Walter, Joan; Meier, Mario; Hafner, Benjamin; Lopez-Ayala, Pedro; Lohrmann, Jens; Troester, Valentina; Koechlin, Luca; Zimmermann, Tobias; Gualandro, Danielle Menosi; Reichlin, Tobias; Lambardi, Florencia; Resi, Silvana; Lima, Alberto Alves de; Trivi, Marcelo; Müeller, Christian

doi:10.1016/j.jacc.2019.05.046

Cited by 144 publications

(128 citation statements)

References 29 publications

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“…The ESC 0/1 hour pathway had an overall NPV of 99.6% (99.0%-99.9%) for 30-day death or myocardial infarction, and was noninferior to standard care. Similar findings were observed in a non-randomised, prospective international multicentre implementation study by Twerenbold et al 7 In 2296 patients with suspected acute coronary syndrome, the ESC 0/1 hour algorithm was followed in 94% of cases, with a median length of stay 2.5 (2.3-4.0) hours. The majority of patients (62%) were ruled out in the emergency department, with just 0.2% (3/1420) of patients experiencing a major adverse cardiovascular event at 30 days.…”

Section: Andrew R Chapman Nicholas L Millssupporting

confidence: 82%

High-sensitivity cardiac troponin and the early rule out of myocardial infarction: time for action

Chapman

2020

Heart

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Section: Andrew R Chapman Nicholas L Millssupporting

confidence: 82%

High-sensitivity cardiac troponin and the early rule out of myocardial infarction: time for action

Chapman

2020

Heart

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“…Recently, the 0/1 hour algorithm has been demonstrated to produce favourable outcomes in real-world implementation. The introduction of the algorithm shortened time to ED discharge and is associated with low rates of adverse cardiac events and mortality 10–12. Our study adds values by demonstrating that the performances of the algorithm based on different hs-cTn assays were comparable.…”

Section: Discussionmentioning

confidence: 63%

“…Even though the ESC 0/1 hour algorithm has been validated in a large number of prospective studies6–12, use of this algorithm has been limited to less than 15% of the hospital institutions globally 13. Because the algorithm has primarily been evaluated in Europe, America and Australasia,6–9 there are some concerns about its safety outside of these settings.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis

Chiang

Lee

et al. 2020

Heart

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ObjectiveThe European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 hour algorithm across different contexts.MethodsWe searched PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome.ResultsA total of 11 014 patients from 10 cohorts were analysed for the primary outcome. The algorithm based on high-sensitivity cardiac troponin (hs-cTn)T (Roche), hs-cTnI (Abbott) and hs-cTnI (Siemens) had pooled sensitivity of 98.4% (95% CI=95.1% to 99.5%), 98.1% (95% CI=94.6% to 99.3%) and 98.7% (95% CI=97.3% to 99.3%), respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% (95% CI=86.0% to 94.6%) and 95.9% (95% CI=94.1% to 97.2%), respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% (95% CI=0.0% to 0.4%) and 0.8% (95% CI=0.5% to 1.2%), respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% (95% CI=0.3% to 1.2%) at 30 days but increased to 8.1% (95% CI=6.1% to 10.4%) at 1 year, comparable to the mortality rate in the rule-in group.ConclusionThe ESC 0/1 hour algorithm has high diagnostic accuracy but may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired.PROSPERO registration numberCRD42019142280.

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“…A follow-up approach was used for pragmatic case adjudication based on 30-day outcomes. This method is routinely applied in diagnostic studies of cardiovascular emergencies in the ED such as pulmonary embolism and acute coronary syndromes and has been used in a previous multicenter study of AASs 12,[28][29][30][31][32] . As compared to our previous work, the timeline of the follow-up was extended from 14 to 30 days, in order to fully cover both the acute and subacute phases of AASs.…”

Section: Discussionmentioning

confidence: 99%

Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes

Morello

Bartalucci

Bironzo

et al. 2020

Sci Rep

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Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017-2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage ® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4-103.2) in AASs and 34.6 ng/mL (IQR 21.4-51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.Acute aortic syndromes (AASs), which include acute aortic dissection (AAD), intramural aortic hematoma (IMH), penetrating aortic ulcer (PAU) and spontaneous aortic rupture (SAR), are severe cardiovascular emergencies affecting 5-10 per 100.000 individuals a year 1 . A conclusive diagnosis of AASs requires advanced aortic imaging, typically computed tomography angiography (CTA), which uses ionizing radiations and may cause contrast-induced nephropathy and anaphylaxis. However, selection of the right patient to image with CTA is cumbersome, because AASs present with unspecific symptoms such as truncal pain, syncope, neurological deficits and hindlimb ischemia. These are leading causes of Emergency Department (ED) visits worldwide, and most patients with these symptoms are affected by more common conditions, such as acute coronary syndromes, gastrointestinal diseases and muscle-skeletal pain. Hence, the misdiagnosis rate of AASs is high, affecting clinical outcomes 2-4 . Increasing use of CTA in EDs has led to a high number of CTA exams requested for suspected AAS turning out negative, but has not substantially changed misdiagnosis rates, indicating that pre-test patient selection remains a key node 5-7 . Development of reliable diagnostic biomarkers discriminating AASs could positively impact on their diagnostic workup, as for other cardiovascular emergencies such as acute coronary syndromes and pulmonary embolism 8,9 . So far, potential biomarkers of AASs have been searched for within aortic layers (e.g. smooth muscle myosin, soluble elastin fragments, calponin, CD40 ligand), within inflammation/remodeling pathways (e.g. matrix metalloproteinases) and within coagulation processes mobilized by blood exposure to non-endo...

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Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction

Cited by 144 publications

References 29 publications

High-sensitivity cardiac troponin and the early rule out of myocardial infarction: time for action

High-sensitivity cardiac troponin and the early rule out of myocardial infarction: time for action

Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis

Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes

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