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

Twerenbold, Raphael; Costabel, Juan Pablo; Nestelberger, Thomas; Campos, Roberto; Wussler, Desiree; Arbucci, Rosina; Cortes, Marcia; Boeddinghaus, Jasper; Baumgartner, Benjamin; Nickel, Christian H; Bingisser, Roland; Badertscher, Patrick; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Wildi, Karin; Rubini Giménez, Maria; Walter, Joan; Meier, Mario; Hafner, Benjamin; Lopez Ayala, Pedro; ... (2019). Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. Journal of the American College of Cardiology, 74(4), pp. 483-494. Elsevier 10.1016/j.jacc.2019.05.046

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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). However, its impact on patient management and safety when routinely applied is unknown. OBJECTIVES This study sought to determine these important real-world outcome data. METHODS In a prospective international study enrolling patients presenting with acute chest discomfort to the emergency department (ED), the authors assessed the real-world performance of the ESC 0/1-h algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care and its associated 30-day rates of major adverse cardiac events (MACE) (the composite of cardiovascular death and MI). RESULTS Among 2,296 patients, non-ST-segment elevation MI prevalence was 9.8%. In median, 1-h blood samples were collected 65 min after the 0-h blood draw. Overall, 94% of patients were managed without protocol violations, and 98% of patients triaged toward rule-out did not require additional cardiac investigations including high-sensitivity cardiac troponin T measurements at later time points or coronary computed tomography angiography in the ED. Median ED stay was 2 h and 30 min. The ESC 0/1-h algorithm triaged 62% of patients toward rule-out, and 71% of all patients underwent outpatient management. Proportion of patients with 30-day MACE were 0.2% (95% confidence interval: 03% to 0.5%) in the rule-out group and 0.1% (95% confidence interval: 0% to 0.2%) in outpatients. Very low MACE rates were confirmed in multiple subgroups, including early presenters. CONCLUSIONS These real-world data document the excellent applicability, short time to ED discharge, and low rate of 30-day MACE associated with the routine clinical use of the ESC 0/1-h algorithm for the management of patients presenting with acute chest discomfort to the ED.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

11 Dec 2019 07:12

Last Modified:

11 Dec 2019 07:12

Publisher DOI:

10.1016/j.jacc.2019.05.046

PubMed ID:

31345421

Uncontrolled Keywords:

0/1-h algorithm acute myocardial infarction high-sensitivity cardiac troponin outcome rule-out safety

URI:

https://boris.unibe.ch/id/eprint/134537

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