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 CH, Chiang CH, Pickering JW, Stoyanov KM, Chew DP, Neumann JT, Ojeda F, Sorensen NA, Su KY, Kavsak P, Worster A, Inoue K, Johannessen TR, Atar D, Amann M, Hochholzer W, Mokhtari A, Ekelund U, Twerenbold R, Mueller C, Bahrmann P, Buttinger N, Dooley M, Ruangsomboon O, Nowak RM, Defilippi CR, Peacock WF, Neilan TG, Liu MA, Hsu WT, Lee GH, Tang PU, Ma KSK, Westermann D, Blankenberg S, Giannitsis E, Than MP, Lee CC (2021)

Publication Type: Journal article, Review article

Publication year: 2021

Journal

DOI: 10.7326/M21-1499

Abstract

Background: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2 hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)- based strategies for triage of patients with suspected acute myocardial infarction (AMI). Purpose: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms. Data Sources: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479) Study Selection: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI. Data Extraction: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality. Data Synthesis: A total of 32 studies (20 cohorts) with 30066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays. Limitation: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies. Conclusion: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.

Authors with CRIS profile

Involved external institutions

Harvard University United States (USA) (US) Taipei Tzu Chi Hospital Taiwan (TW) University of Sussex United Kingdom (GB) University of Otago New Zealand (NZ) Juntendo University Japan (JP) Houston Texas Medical Center United States (USA) (US) McMaster University Canada (CA) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) University of Oslo Norway (NO) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) Monash University Australia (AU) National Taiwan University Hospital (NTUH) / 國立台灣大學醫學院附設醫院 Taiwan (TW) Universitätsklinikum Heidelberg Germany (DE) Universität Basel Switzerland (CH) Massachusetts General Hospital United States (USA) (US) Lund University / Lunds universitet Sweden (SE) Henry Ford Health System (HFHS) United States (USA) (US) Brown University United States (USA) (US) Inova Fairfax Hospital (IFH) United States (USA) (US) Mahidol University / มหาวิทยาลัยมหิดล Thailand (TH) University of Pennsylvania United States (USA) (US) Flinders University Australia (AU)

How to cite

APA:

Chiang, C.-H., Chiang, C.-H., Pickering, J.W., Stoyanov, K.M., Chew, D.P., Neumann, J.T.,... Lee, C.-C. (2021). 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. Annals of Internal Medicine. https://dx.doi.org/10.7326/M21-1499

MLA:

Chiang, Cho-Han, et al. "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." Annals of Internal Medicine (2021).

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