Raphael Twerenbold1, Juan Pablo Costabel2, Thomas Nestelberger3, Roberto Campos3, Desiree Wussler4, Rosina Arbucci3, Marcia Cortes3, Jasper Boeddinghaus4, Benjamin Baumgartner5, Christian H Nickel6, Roland Bingisser6, Patrick Badertscher7, Christian Puelacher4, Jeanne du Fay de Lavallaz4, Karin Wildi5, Maria Rubini Giménez5, Joan Walter4, Mario Meier5, Benjamin Hafner5, Pedro Lopez Ayala5, Jens Lohrmann8, Valentina Troester5, Luca Koechlin9, Tobias Zimmermann5, Danielle M Gualandro5, Tobias Reichlin10, Florencia Lambardi3, Silvana Resi3, Alberto Alves de Lima3, Marcelo Trivi3, Christian Mueller11. 1. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: https://twitter.com/Rtwerenbold. 2. Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. Electronic address: https://twitter.com/jpcostabel. 3. Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 4. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 5. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. 6. Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland. 7. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois. 8. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland. 9. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland. 10. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. 11. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy. Electronic address: christian.mueller@usb.ch.
Abstract
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.
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.
Authors: Tonje R Johannessen; Sigrun Halvorsen; Dan Atar; John Munkhaugen; Anne Kathrine Nore; Torbjørn Wisløff; Odd Martin Vallersnes Journal: BMC Health Serv Res Date: 2022-10-21 Impact factor: 2.908
Authors: Atul Anand; Kuan Ken Lee; Andrew R Chapman; Amy V Ferry; Phil D Adamson; Fiona E Strachan; Colin Berry; Iain Findlay; Anne Cruikshank; Alan Reid; Paul O Collinson; Fred S Apple; David A McAllister; Donogh Maguire; Keith A A Fox; David E Newby; Chris Tuck; Ronald Harkess; Catriona Keerie; Christopher J Weir; Richard A Parker; Alasdair Gray; Anoop S V Shah; Nicholas L Mills Journal: Circulation Date: 2021-03-23 Impact factor: 39.918
Authors: Hilde L Tjora; Ole-Thomas Steiro; Jørund Langørgen; Rune Bjørneklett; Ottar K Nygård; Øyvind Skadberg; Vernon V S Bonarjee; Paul Collinson; Torbjørn Omland; Kjell Vikenes; Kristin M Aakre Journal: J Am Heart Assoc Date: 2020-11-26 Impact factor: 5.501
Authors: Cian P McCarthy; Johannes T Neumann; Sam A Michelhaugh; Nasrien E Ibrahim; Hanna K Gaggin; Nils A Sörensen; Sarina Schäefer; Tanja Zeller; Craig A Magaret; Grady Barnes; Rhonda F Rhyne; Dirk Westermann; James L Januzzi Journal: J Am Heart Assoc Date: 2020-08-06 Impact factor: 5.501
Authors: Ryan Wereski; Dorien M Kimenai; Caelan Taggart; Dimitrios Doudesis; Kuan Ken Lee; Matthew T H Lowry; Anda Bularga; David J Lowe; Takeshi Fujisawa; Fred S Apple; Paul O Collinson; Atul Anand; Andrew R Chapman; Nicholas L Mills Journal: Circulation Date: 2021-06-25 Impact factor: 29.690