0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction

Area of Science:

• Cardiology
• Renal Medicine
• Diagnostic Accuracy

Background:

• The European Society of Cardiology (ESC) recommends a 0/1-hour algorithm using high-sensitivity cardiac troponin (hs-cTn) for rapid diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI).
• Patients with renal dysfunction (RD) often have elevated hs-cTn levels, raising concerns about the algorithm's performance in this population.
• RD is defined as an estimated glomerular filtration rate <60 mL/min/1.73 m².

Purpose of the Study:

• To assess the diagnostic performance of the ESC 0/1-hour hs-cTn algorithm in patients with RD.
• To compare the algorithm's safety, accuracy, and efficacy in patients with and without RD.
• To evaluate the impact of modified thresholds on algorithm performance in RD.

Main Methods:

• Prospective, multicenter diagnostic study.
• Enrolled unselected patients presenting to the emergency department with suspected NSTEMI.
• Assessed hs-cTnT and hs-cTnI performance using the ESC 0/1-hour algorithm, comparing patients with RD to those with normal renal function.
• Final diagnosis adjudicated by independent cardiologists.

Main Results:

• RD was present in 15% of 3254 patients; NSTEMI prevalence was higher in RD patients (31% vs 13%).
• Using hs-cTnT, RD patients had comparable rule-out sensitivity (100.0% vs 99.2%) but lower rule-in specificity (88.7% vs 96.5%) and overall efficacy (51% vs 81%).
• Similar trends observed with hs-cTnI: comparable rule-out sensitivity (98.6% vs 98.5%) but lower rule-in specificity (84.4% vs 91.7%) and efficacy (54% vs 76%) in RD patients.

Conclusions:

• The ESC 0/1-hour algorithm demonstrates high safety (rule-out sensitivity) in patients with RD.
• However, rule-in specificity and overall algorithm efficacy are decreased in patients with RD.
• Modifying algorithm thresholds did not enhance safety or efficacy in the RD subgroup.