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Direct Comparison of the European Society of Cardiology 0/1-Hour Vs. 0/2-Hour Algorithms in Patients with Acute Chest Pain

Engström, Agnes LU ; Mokhtari, Arash LU and Ekelund, Ulf LU orcid (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.

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author
; and
organization
publishing date
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
  • scopus:85194035132
  • pmid:38789353
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 &lt; 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}},
}