The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: an observational study

Ruangsomboon, Onlak; Mekavuthikul, Pattaraporn; Chakorn, Tipa; Monsomboon, Apichaya; Prapruetkit, Nattakarn; Surabenjawong, Usapan; Limsuwat, Chok; Riyapan, Sattha; Chaisirin, Wansiri

doi:10.1186/s12245-018-0204-9

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…After title and abstract screening, 54 studies were eligible for full-text review. After full-text review, a total of 15 studies were included for analysis(figure 1)6 7 9 14–16 28–36.…”

Section: Resultsmentioning

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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“…After title and abstract screening, 54 studies were eligible for full-text review. After full-text review, a total of 15 studies were included for analysis(figure 1)6 7 9 14–16 28–36.…”

Section: Resultsmentioning

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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“…Another trial aimed to investigate differences between a 0/3‐ and a 0/1‐hsTnt‐algorithm and found comparable performance. Noteworthy, the onset of chest pain was significantly different between the study groups 18 . Our results did not include a 0/1 hour‐algortithm, warranting future research.…”

Section: Discussionmentioning

confidence: 70%

“…Noteworthy, the onset of chest pain was significantly different between the study groups. 18 Our results did not include a 0/1 houralgortithm, warranting future research.…”

mentioning

confidence: 81%

Impact of more conservative European Society of Cardiology guidelines on the management of patients with acute chest pain

Kienbacher

Fuhrmann

Tulder

et al. 2021

Int J Clinical Practice

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Objective Early diagnosis or rule‐out of acute coronary syndrome (ACS) is a key competence of emergency medicine. Changes in the NSTE‐ACS guidelines of the European Society of Cardiology (ESC) in 2015 and 2020 both warranted a henceforth more conservative approach regarding high‐sensitivity troponin t (hsTnt) testing. We aimed to assess the impact of more conservative guidelines on the frequency of early rule‐out and prolonged observation with repeated hsTnt testing at a high‐volume tertiary care emergency department. Patients and Methods We conducted a pre‐ and post‐changeover analysis 3 months before and 3 months after transition from less (hsTnt cut‐off 30 ng/L, 3‐hour rule‐out) to more conservative (hsTnt cut‐off 14 ng/L, 1‐hour rule‐out) guidelines in 2015, comparing proportions of patients requiring repeated testing. Results We included 5442 cases of symptoms suspicious of acute cardiac origin (3451 before, 1991 after, 2370 (44%) female, age 55 (SD 19) years). The proportion of patients fulfilling early‐rule out criteria decreased from 68% (2348 patients) before to 60% (1195 patients) with the 2015 guidelines (P < .01). Those requiring repeated testing significantly (P < .01) increased from 22% (743 patients) to 25% (494 patients). Positive results in repeated testing significantly (P = .02) decreased from 43% (320 patients) to 37% (181 patients). Invasive diagnostics were performed in 91 patients (2.6%) before and in 75 patients (3.8%) after (P = .02) the guideline revision. Conclusion The implementation of the more conservative 2015 ESC guidelines led to a minor rise in prolonged observations because of an increase in negative repeated testing and to an increase in invasive procedures.

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The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients

Ruangsomboon¹,

Thirawattanasoot

Chakorn

et al. 2021

International Journal of Cardiology

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The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: an observational study

Cited by 4 publications

References 16 publications

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

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

Impact of more conservative European Society of Cardiology guidelines on the management of patients with acute chest pain

The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients

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