Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction.

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Triage

Background:

• The European Society of Cardiology (ESC) recommends the 0/1-h algorithm for rapid triage of patients with suspected non-ST-segment elevation myocardial infarction (MI).
• The real-world impact and safety of routinely applying this algorithm remain largely unknown.

Purpose of the Study:

• To assess the real-world performance of the ESC 0/1-h algorithm in patients presenting with acute chest discomfort.
• To determine the associated 30-day rates of major adverse cardiac events (MACE).

Main Methods:

• Prospective international study of 2,296 patients in emergency departments (ED) with acute chest discomfort.
• Utilized high-sensitivity cardiac troponin T assays within routine clinical care.
• Assessed 30-day MACE, defined as cardiovascular death and MI.

Main Results:

• The ESC 0/1-h algorithm triaged 62% of patients for rule-out, with 71% managed as outpatients.
• Median ED stay was 2.5 hours; 98% of rule-out patients avoided further cardiac investigations.
• 30-day MACE rates were low: 0.2% in the rule-out group and 0.1% in outpatients.

Conclusions:

• Routine clinical use of the ESC 0/1-h algorithm demonstrates excellent applicability in ED settings.
• The algorithm facilitates short ED discharge times and a low rate of 30-day MACE.
• Real-world data support the safety and efficacy of the ESC 0/1-h algorithm for acute chest discomfort management.