Masayuki Shiozaki1, Kenji Inoue2, Satoru Suwa3, Chien-Chang Lee4, Shuo-Ju Chiang5, Akihiro Sato1, Megumi Shimizu1, Kentaro Fukuda1, Masaru Hiki1, Naozumi Kubota1, Hiroshi Tamura1, Yasumasa Fujiwara1, Shohei Ouchi6, Tetsuro Miyazaki6, Yohei Hirano7, Hiroshi Tanaka7, Manabu Sugita8, Yuji Nakazato6, Masataka Sumiyoshi1, Hiroyuki Daida9. 1. Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan. 2. Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan. Electronic address: inouek@juntendo-nerima.jp. 3. Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan. 4. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. 5. Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taiwan. 6. Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan. 7. Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan. 8. Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan. 9. Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: The European Society of Cardiology (ESC) recommends a 0-h/1-h (0/1-h) algorithm to classify patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI). However, reliable evidence about patients who present early after the onset of symptoms is limited, likely because high-sensitivity cardiac troponin (hs-cTn) values cannot increase sufficiently within that time. This study aimed to evaluate the outcomes in real-world situations that utilized the 0/1-h algorithm. METHODS: In a prospective, international, multicenter cohort study that enrolled 1638 patients presenting with acute chest pain to the emergency department, we assessed the performance of the 0/1-h algorithm using hs-cTnT and the associated 30-day rates of major adverse cardiac events: death and acute myocardial infarction (AMI). RESULTS: Among 1074 patients, the prevalence of AMI was 16.0%. An approximately 60.1% (n = 645) of patients visited the hospital within 3 h after onset of chest pain (less than 1 h; 18.2% [n = 196], less than 2 h; 27.5% [n = 295], and less than 3 h; 14.3% [n = 154]). Moreover, the prevalence rates of AMI were similar at all times (1 h, 16.8%; 1-2 h, 20.7%; 2-3 h, 18.2%; p = .5). According to the ESC 0/1-h algorithm, the distribution patterns of rule-out, observe, and rule-in groups were similar; however, none of the patients was diagnosed with AMI or cardiac death in the rule-out group. CONCLUSION: This study revealed the applicability of the 0/1-h algorithm for the management of early presenters.
BACKGROUND: The European Society of Cardiology (ESC) recommends a 0-h/1-h (0/1-h) algorithm to classify patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI). However, reliable evidence about patients who present early after the onset of symptoms is limited, likely because high-sensitivity cardiac troponin (hs-cTn) values cannot increase sufficiently within that time. This study aimed to evaluate the outcomes in real-world situations that utilized the 0/1-h algorithm. METHODS: In a prospective, international, multicenter cohort study that enrolled 1638 patients presenting with acute chest pain to the emergency department, we assessed the performance of the 0/1-h algorithm using hs-cTnT and the associated 30-day rates of major adverse cardiac events: death and acute myocardial infarction (AMI). RESULTS: Among 1074 patients, the prevalence of AMI was 16.0%. An approximately 60.1% (n = 645) of patients visited the hospital within 3 h after onset of chest pain (less than 1 h; 18.2% [n = 196], less than 2 h; 27.5% [n = 295], and less than 3 h; 14.3% [n = 154]). Moreover, the prevalence rates of AMI were similar at all times (1 h, 16.8%; 1-2 h, 20.7%; 2-3 h, 18.2%; p = .5). According to the ESC 0/1-h algorithm, the distribution patterns of rule-out, observe, and rule-in groups were similar; however, none of the patients was diagnosed with AMI or cardiac death in the rule-out group. CONCLUSION: This study revealed the applicability of the 0/1-h algorithm for the management of early presenters.