Direct Comparison of the European Society of Cardiology 0/1-Hour Vs. 0/2-Hour Algorithms in Patients with Acute Chest Pain
(2024) In Journal of Emergency Medicine 66(6). p.651-659- Abstract
Background: The recent guidelines from the European Society of Cardiology recommends using high-sensitivity cardiac troponin (hs-cTn) in either 0/1-h or 0/2-h algorithms to identify or rule out acute myocardial infarction (AMI). Several studies have reported good diagnostic accuracy with both algorithms, but few have compared the algorithms directly. Objective: We aimed to compare the diagnostic accuracy of the algorithms head-to-head, in the same patients. Methods: This was a secondary analysis of data from a prospective observational study; 1167 consecutive patients presenting with chest pain to the emergency department at Skåne University Hospital (Lund, Sweden) were enrolled. Only patients with a hs-cTnT sample at presentation AND... (More)
Background: The recent guidelines from the European Society of Cardiology recommends using high-sensitivity cardiac troponin (hs-cTn) in either 0/1-h or 0/2-h algorithms to identify or rule out acute myocardial infarction (AMI). Several studies have reported good diagnostic accuracy with both algorithms, but few have compared the algorithms directly. Objective: We aimed to compare the diagnostic accuracy of the algorithms head-to-head, in the same patients. Methods: This was a secondary analysis of data from a prospective observational study; 1167 consecutive patients presenting with chest pain to the emergency department at Skåne University Hospital (Lund, Sweden) were enrolled. Only patients with a hs-cTnT sample at presentation AND after 1 AND 2 h were included in the analysis. We compared sensitivity, specificity, and negative (NPV) and positive predictive value (PPV). The primary outcome was index visit AMI. Results: A total of 710 patients were included, of whom 56 (7.9%) had AMI. Both algorithms had a sensitivity of 98.2% and an NPV of 99.8% for ruling out AMI, but the 0/2-h algorithm ruled out significantly more patients (69.3% vs. 66.2%, p < 0.001). For rule-in, the 0/2-h algorithm had higher PPV (73.4% vs. 65.2%) and slightly better specificity (97.4% vs. 96.3%, p = 0.016) than the 0/1-h algorithm. Conclusion: Both algorithms had good diagnostic accuracy, with a slight advantage for the 0/2-h algorithm. Which algorithm to implement may thus depend on practical issues such as the ability to exploit the theoretical time saved with the 0/1-h algorithm. Further studies comparing the algorithms in combination with electrocardiography, history, or risk scores are needed.
(Less)
- author
- Engström, Agnes LU ; Mokhtari, Arash LU and Ekelund, Ulf LU
- organization
- publishing date
- 2024-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- 0/1-hour algorithm, 0/2-hour algorithm, Acute myocardial infarction, Cardiac enzymes, Chest pain, Troponin
- in
- Journal of Emergency Medicine
- volume
- 66
- issue
- 6
- pages
- 651 - 659
- publisher
- Elsevier
- external identifiers
-
- pmid:38789353
- scopus:85194035132
- ISSN
- 0736-4679
- DOI
- 10.1016/j.jemermed.2024.02.004
- language
- English
- LU publication?
- yes
- id
- 38ea1fe9-1276-42ce-9de9-9665aae43b94
- date added to LUP
- 2024-06-14 15:43:24
- date last changed
- 2024-06-15 02:52:49
@article{38ea1fe9-1276-42ce-9de9-9665aae43b94, abstract = {{<p>Background: The recent guidelines from the European Society of Cardiology recommends using high-sensitivity cardiac troponin (hs-cTn) in either 0/1-h or 0/2-h algorithms to identify or rule out acute myocardial infarction (AMI). Several studies have reported good diagnostic accuracy with both algorithms, but few have compared the algorithms directly. Objective: We aimed to compare the diagnostic accuracy of the algorithms head-to-head, in the same patients. Methods: This was a secondary analysis of data from a prospective observational study; 1167 consecutive patients presenting with chest pain to the emergency department at Skåne University Hospital (Lund, Sweden) were enrolled. Only patients with a hs-cTnT sample at presentation AND after 1 AND 2 h were included in the analysis. We compared sensitivity, specificity, and negative (NPV) and positive predictive value (PPV). The primary outcome was index visit AMI. Results: A total of 710 patients were included, of whom 56 (7.9%) had AMI. Both algorithms had a sensitivity of 98.2% and an NPV of 99.8% for ruling out AMI, but the 0/2-h algorithm ruled out significantly more patients (69.3% vs. 66.2%, p < 0.001). For rule-in, the 0/2-h algorithm had higher PPV (73.4% vs. 65.2%) and slightly better specificity (97.4% vs. 96.3%, p = 0.016) than the 0/1-h algorithm. Conclusion: Both algorithms had good diagnostic accuracy, with a slight advantage for the 0/2-h algorithm. Which algorithm to implement may thus depend on practical issues such as the ability to exploit the theoretical time saved with the 0/1-h algorithm. Further studies comparing the algorithms in combination with electrocardiography, history, or risk scores are needed.</p>}}, author = {{Engström, Agnes and Mokhtari, Arash and Ekelund, Ulf}}, issn = {{0736-4679}}, keywords = {{0/1-hour algorithm; 0/2-hour algorithm; Acute myocardial infarction; Cardiac enzymes; Chest pain; Troponin}}, language = {{eng}}, number = {{6}}, pages = {{651--659}}, publisher = {{Elsevier}}, series = {{Journal of Emergency Medicine}}, title = {{Direct Comparison of the European Society of Cardiology 0/1-Hour Vs. 0/2-Hour Algorithms in Patients with Acute Chest Pain}}, url = {{http://dx.doi.org/10.1016/j.jemermed.2024.02.004}}, doi = {{10.1016/j.jemermed.2024.02.004}}, volume = {{66}}, year = {{2024}}, }