One-Year Outcome of Patients with Chest Pain in the Rule-Out Group According to the 0-Hour/1-Hour Algorithm

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• The 0-hour/1-hour algorithm is recommended for non-ST-elevation myocardial infarction risk stratification.
• Limited data exists on the long-term prognosis of patients in the rule-out group.

Purpose of the Study:

• To assess the safety and effectiveness of the 0-hour/1-hour algorithm in emergency department patients with suspected acute coronary syndrome (ACS).
• To evaluate the 1-year prognosis for patients stratified into the rule-out group using this algorithm.

Main Methods:

• Prospective pre-post study involving 1106 emergency department patients with possible ACS across 4 hospitals.
• Analysis of 1-year follow-up data, including health records and phone calls, to determine major adverse cardiovascular events.
• Patients were stratified using the 0-hour/1-hour algorithm, with 47.0% placed in the rule-out group.

Main Results:

• Over 1-year follow-up (86.9% follow-up rate), no cardiovascular deaths or subsequent acute myocardial infarctions (AMI) occurred in the rule-out group.
• Among 27 patients undergoing procedures within 30 days, 0.7% had a stroke, 1.3% died of non-cardiovascular causes, and 6.7% had revascularization within 1 year.
• The algorithm demonstrated very low rates of adverse events in the rule-out population.

Conclusions:

• Implementation of the 0-hour/1-hour algorithm is safe and effective for emergency department patients with possible ACS.
• The algorithm successfully identifies a low-risk group, minimizing the need for further cardiac investigations.
• Long-term follow-up supports the reliability of the 0-hour/1-hour algorithm in clinical practice.