Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction

Chiang, Cheng‐Yang; Chiang, Chun‐Pin; Pickering, John W.; Stoyanov, Kiril M; Chew, Derek P.; Neumann, Johannes; Ojeda, Francisco; Sörensen, Nils Arne; Su, Ke‐Ying; Kavsak, Peter A.; Worster, Andrew; Inoue, Kenji; Johannessen, Tonje R.; Atar, Dan; Amann, Michael; Hochholzer, Willibald; Mokhtari, Arash; Ekelund, Ulf; Twerenbold, Raphael; Müller, Christian; Bahrmann, Philipp; Buttinger, Nicolas; Dooley, Maureen; Ruangsomboon, Onlak; Nowak, Richard M.; deFilippi, Christopher; Peacock, W. Frank; Neilan, Tomas G.; Liu, Michael A.; Hsu, Wan‐Ting; Lee, Gin Hoong; Tang, Pui-Un; Westermann, Dirk; Blankenberg, Stefan; Giannitsis, Evangelos; Than, Martin; Lee, Chien‐Chang

doi:10.7326/m21-1499

Cited by 54 publications

(41 citation statements)

References 64 publications

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“…In a collaborative meta-analysis of 9241 patients, Pickering et al 4 demonstrated that low-risk patients defined as those with a nonischemic ECG and a hs-cTnT<5 ng/L had a pooled sensitivity of 98.7% for acute myocardial infarction and 98.0% for 30-day major adverse cardiac events and no low-risk patients died. In another recent international collaborative meta-analysis, 6 both the ESC 0/1-hour and 0/2-hour hs-cTnT protocols incorporating single-sample rule-out using hs-cTnT<5 ng/L were evaluated. The ESC 0/1-hour protocol was evaluated in 13 899 patients across 12 cohorts and demonstrated a sensitivity of 99.2% and NPV of 99.8%.…”

Section: Discussionmentioning

confidence: 99%

“…6 The ESC 0/2-hour protocol was evaluated in 2488 patients across 5 cohorts and demonstrated a sensitivity of 99.0% and NPV of 99.5%. 6 Implementation data 13 from Scotland also confirm safety with cardiovascular death occurring in only 0.1% at both 30 days and 1 year in those with hs-cTnT<5 ng/L in the intervention group. Our data complement the vast experience on the LoD of hs-cTnT<5 ng/L and demonstrate that the LoQ of hs-cTnT<6 ng/L is also safe.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation

Sandoval

Lewis

Mehta³

et al. 2022

Circulation

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Background: There are good data to support using a single high-sensitivity cardiac troponin T (hs-cTnT) below the limit of detection (LoD) of 5 ng/L to exclude acute myocardial infarction. Per the United States (US) Food and Drug Administration (FDA), hs-cTnT can only report to the limit of quantitation (LoQ) of 6 ng/L, a threshold for which there is limited data. Our goal was to determine whether a single hs-cTnT below the LoQ of 6 ng/L is a safe strategy to identify patients at low-risk for acute myocardial injury and infarction. Methods: The efficacy (proportion identified as low-risk based on baseline hs-cTnT<6 ng/L) of identifying low-risk patients was examined in a multicenter (n=22 sites) US cohort study of emergency department patients undergoing at least one hs-cTnT (CV Data Mart Biomarker cohort). We then determined the performance of a single hs-cTnT<6 ng/L (biomarker alone) to exclude acute myocardial injury (subsequent hs-cTnT >99 th percentile in those with an initial hs-cTnT<6 ng/L). The clinically intended rule-out strategy combining a nonischemic electrocardiogram with a baseline hs-cTnT<6 ng/L was subsequently tested in an adjudicated cohort in which the diagnostic performance for ruling-out acute myocardial infarction and safety (myocardial infarction or death at 30-days) were evaluated. Results: A total of 85,610 patients were evaluated in the CV Data Mart Biomarker cohort, amongst which 24,646 (29%) had a baseline hs-cTnT<6 ng/L. Women were more likely than men to have hs-cTnT<6 ng/L (38% vs. 20%, p<0.0001). Among 11,962 patients with baseline hs-cTnT<6 ng/L and serial measurements, only 1.2% developed acute myocardial injury, resulting in a negative predictive value of 98.8% (95% CI 98.6, 99.0) and sensitivity of 99.6% (95% CI 99.5, 99.6). In the adjudicated cohort, a nonischemic electrocardiogram with hs-cTnT<6 ng/L identified 33% of patients (610 of 1849) as low-risk and resulted in a negative predictive value and sensitivity of 100% and a 30-day rate of 0.2% for 30-day myocardial infarction or death. Conclusions: A single hs-cTnT below the LoQ of 6 ng/L is a safe and rapid method to identify a substantial number of patients at very low risk for acute myocardial injury and infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation

Sandoval

Lewis

Mehta³

et al. 2022

Circulation

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“…The systematic review identified 32 publications ( n = 30,066 patients; 4246 cases of AMI) conducted in Asia, Australasia, Europe, and North America that met the inclusion criteria 9 . Among these 32 papers, they identified 33 total cohorts, of which 20 were unique subgroups.…”

Section: Narrativementioning

confidence: 99%

Accuracy of the European Society of Cardiology 0/1‐, 0/2‐, and 0/3‐hour algorithms for diagnosing acute myocardial infarction

Long

Gottlieb²

2022

Academic Emergency Medicine

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“…Previous studies propose that inflammation caused by viral [ 37 , 38 ] or bacterial [ 39 , 40 , 41 , 42 , 43 , 44 ] pathogens plays an important role in atherosclerosis pathogenesis. Specifically, previous studies have shown that herpes zoster virus, Chlamydia pneumoniae , cytomegalovirus, and hepatitis A virus infection can increase the risk of CAD, myocardial infarction, and even cardiovascular death [ 45 , 46 , 47 , 48 , 49 ]. For instance, previous studies using data from the National Health and Nutrition Examination Survey (NHANES) demonstrated that HPV infection is associated with CVD among women [ 50 ].…”

Section: Introductionmentioning

confidence: 99%

Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study

Juang

Sheng‐Kai

Kao

et al. 2022

JPM

Self Cite

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Background: Male patients with genital warts are known for higher rates of sexual dysfunction. This study was conducted to investigate whether human papillomaviruses (HPV) infection is associated with an increased risk of erectile dysfunction (ED). Methods: Patients aged over 18 with HPV infection (n = 13,296) and propensity score-matched controls (n = 53,184) were recruited from the Longitudinal Health Insurance Database (LHID). The primary endpoint was the diagnosis of ED. Chi-square tests were used to analyze the distribution of demographic characteristics. The Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of ED in both groups, after adjusting for sex, age, relevant comorbidities, co-medication, and surgery. Results: ED developed in 181 patients of the study group. The incidence density of ED was 2.53 per 1000 person-years for the HPV group and 1.51 per 1000 person-years for the non-HPV group, with an adjusted HR (95% CI) of 1.63 (1.37–1.94). In stratification analysis, adjusted HR of diabetes-, chronic obstructive pulmonary disease (COPD-), and stroke-subgroup were 2.39, 2.51, and 4.82, with significant p values for interaction, respectively. Sensitivity analysis yields consistent findings. Conclusions: The patients with HPV infection had a higher risk of subsequent ED in comparison to the non-HPV controls. The mechanism behind such association and its possible role in ED prevention deserves further study in the future.

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Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction

Cited by 54 publications

References 64 publications

Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation

Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation

Accuracy of the European Society of Cardiology 0/1‐, 0/2‐, and 0/3‐hour algorithms for diagnosing acute myocardial infarction

Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study

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