Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis
(2022) In Annals of Internal Medicine 175(1). p.101-113- Abstract
BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).
PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.
DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).
STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting... (More)
BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).
PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.
DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).
STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.
DATA EXTRACTION: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.
DATA SYNTHESIS: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.
LIMITATION: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.
CONCLUSION: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.
PRIMARY FUNDING SOURCE: National Taiwan University Hospital.
(Less)
- author
- Chiang, Cho-Han
; Chiang, Cho-Hung
; Pickering, John W
; Stoyanov, Kiril M
; Chew, Derek P
; Neumann, Johannes T
; Ojeda, Francisco
; Sörensen, Nils A
; Su, Ke-Ying
; Kavsak, Peter
; Worster, Andrew
; Inoue, Kenji
; Johannessen, Tonje R
; Atar, Dan
; Amann, Michael
; Hochholzer, Willibald
; Mokhtari, Arash
LU
; Ekelund, Ulf
LU
; Twerenbold, Raphael
; Mueller, Christian
; Bahrmann, Philipp
; Buttinger, Nicolas
; Dooley, Maureen
; Ruangsomboon, Onlak
; Nowak, Richard M
; DeFilippi, Christopher R
; Peacock, William F
; Neilan, Tomas G
; Liu, Michael A
; Hsu, Wan-Ting
; Lee, Gin Hoong
; Tang, Pui-Un
; Ma, Kevin Sheng-Kai
; Westermann, Dirk
; Blankenberg, Stefan
; Giannitsis, Evangelos
; Than, Martin P
and Lee, Chien-Chang
(Less) - organization
- publishing date
- 2022-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Algorithms, Biomarkers/blood, Diagnosis, Differential, Europe, Humans, Myocardial Infarction/diagnosis, Practice Guidelines as Topic, Predictive Value of Tests, Reproducibility of Results, Risk Factors, Societies, Medical, Time Factors, Triage/methods, Troponin/blood
- in
- Annals of Internal Medicine
- volume
- 175
- issue
- 1
- pages
- 101 - 113
- publisher
- American College of Physicians
- external identifiers
-
- pmid:34807719
- scopus:85122892707
- ISSN
- 0003-4819
- DOI
- 10.7326/M21-1499
- language
- English
- LU publication?
- yes
- id
- ca5f0c0c-51b7-49ae-ac86-76828d512018
- date added to LUP
- 2022-09-29 20:54:22
- date last changed
- 2024-06-13 19:50:42
@article{ca5f0c0c-51b7-49ae-ac86-76828d512018,
abstract = {{<p>BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).</p><p>PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.</p><p>DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).</p><p>STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.</p><p>DATA EXTRACTION: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.</p><p>DATA SYNTHESIS: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.</p><p>LIMITATION: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.</p><p>CONCLUSION: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.</p><p>PRIMARY FUNDING SOURCE: National Taiwan University Hospital.</p>}},
author = {{Chiang, Cho-Han and Chiang, Cho-Hung and Pickering, John W and Stoyanov, Kiril M and Chew, Derek P and Neumann, Johannes T and Ojeda, Francisco and Sörensen, Nils A and Su, Ke-Ying and Kavsak, Peter and Worster, Andrew and Inoue, Kenji and Johannessen, Tonje R and Atar, Dan and Amann, Michael and Hochholzer, Willibald and Mokhtari, Arash and Ekelund, Ulf and Twerenbold, Raphael and Mueller, Christian and Bahrmann, Philipp and Buttinger, Nicolas and Dooley, Maureen and Ruangsomboon, Onlak and Nowak, Richard M and DeFilippi, Christopher R and Peacock, William F and Neilan, Tomas G and Liu, Michael A and Hsu, Wan-Ting and Lee, Gin Hoong and Tang, Pui-Un and Ma, Kevin Sheng-Kai and Westermann, Dirk and Blankenberg, Stefan and Giannitsis, Evangelos and Than, Martin P and Lee, Chien-Chang}},
issn = {{0003-4819}},
keywords = {{Algorithms; Biomarkers/blood; Diagnosis, Differential; Europe; Humans; Myocardial Infarction/diagnosis; Practice Guidelines as Topic; Predictive Value of Tests; Reproducibility of Results; Risk Factors; Societies, Medical; Time Factors; Triage/methods; Troponin/blood}},
language = {{eng}},
number = {{1}},
pages = {{101--113}},
publisher = {{American College of Physicians}},
series = {{Annals of Internal Medicine}},
title = {{Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis}},
url = {{http://dx.doi.org/10.7326/M21-1499}},
doi = {{10.7326/M21-1499}},
volume = {{175}},
year = {{2022}},
}