Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial...

Area of Science:

• Cardiology
• Emergency Medicine
• Biomarker Analysis

Background:

• New European Society of Cardiology guidelines recommend a 0- and 1-hour rapid assessment algorithm for acute myocardial infarction (AMI) using high-sensitivity cardiac troponin.
• Emergency department physicians need high sensitivity to rule out AMI, while cardiologists aim to minimize false positives.

Purpose of the Study:

• To evaluate the performance of the European Society of Cardiology rapid assessment algorithm using both high-sensitivity troponin I and T assays.
• To assess the sensitivity, rule-out proportion, positive predictive value, and rule-in proportion for each troponin assay.

Main Methods:

• A study involving 2222 patients presenting with chest pain was conducted across New Zealand, Australia, and Canada.
• Serial high-sensitivity troponin I and T measurements were taken, with AMI outcomes adjudicated by at least two physicians.
• The performance of the European Society of Cardiology algorithm was assessed for each assay.

Main Results:

• The high-sensitivity troponin T algorithm ruled out 64.1% of patients with 97.1% sensitivity and ruled in 13.1% with a 63.4% positive predictive value.
• The high-sensitivity troponin I algorithm ruled out 54.2% of patients with 98.8% sensitivity and ruled in 14.0% with a 68.1% positive predictive value.
• Both algorithms demonstrated modest positive predictive values.

Conclusions:

• The sensitivity of the 0-/1-hour algorithm using high-sensitivity troponin may be insufficient for emergency physicians to confidently rule out AMI.
• These algorithms can be valuable for identifying patients needing expedited management.
• The positive predictive value for both high-sensitivity troponin T and I algorithms was modest.