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

2019; Elsevier BV; Volume: 74; Issue: 4 Linguagem: Inglês

10.1016/j.jacc.2019.05.046

1558-3597

Raphael Twerenbold, Juan Pablo Costabel, Thomas Nestelberger, Roberto Campos, Desiree Wussler, Rosina Arbucci, Marcia Cortés, Jasper Boeddinghaus, Benjamin Baumgartner, Christian H. Nickel, Roland Bingisser, Patrick Badertscher, Christian Puelacher, Jeanne du Fay de Lavallaz, Karin Wildi, María Rubini Giménez, Joan Walter, Mario Meier, Benjamin Hafner, Pedro López‐Ayala, Jens Lohrmann, Valentina Troester, Luca Koechlin, Tobias Zimmermann, Danielle Menosi Gualandro, Tobias Reichlin, Florencia Lambardi, Silvana Resi, Alberto Alves de Lima, Marcelo Trivi, Christian Mueller,

Cardiac Arrest and Resuscitation

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. This study sought to determine these important real-world outcome data. 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). 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. 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.