Cho-Han Chiang1, Cho-Hung Chiang2, John W Pickering3, Kiril M Stoyanov4, Derek P Chew5, Johannes T Neumann6, Francisco Ojeda7, Nils A Sörensen7, Ke-Ying Su8, Peter Kavsak9, Andrew Worster9, Kenji Inoue10, Tonje R Johannessen11, Dan Atar12, Michael Amann13, Willibald Hochholzer13, Arash Mokhtari14, Ulf Ekelund14, Raphael Twerenbold15, Christian Mueller16, Philipp Bahrmann17, Nicolas Buttinger18, Maureen Dooley18, Onlak Ruangsomboon19, Richard M Nowak20, Christopher R DeFilippi21, William F Peacock22, Tomas G Neilan23, Michael A Liu24, Wan-Ting Hsu25, Gin Hoong Lee8, Pui-Un Tang8, Kevin Sheng-Kai Ma26, Dirk Westermann7, Stefan Blankenberg7, Evangelos Giannitsis4, Martin P Than27, Chien-Chang Lee28. 1. Harvard Medical School, Boston, Massachusetts, and National Taiwan University College of Medicine, Taipei, Taiwan (Cho-Han Chiang). 2. Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan (Cho-Hung Chiang). 3. Christchurch Hospital and University of Otago Christchurch, Christchurch, New Zealand (J.W.P.). 4. University Hospital of Heidelberg, Heidelberg, Germany (K.M.S., E.G.). 5. Flinders University of South Australia, Adelaide, Australia (D.P.C.). 6. Monash University, Melbourne, Australia, and University Heart & Vascular Center Hamburg, Hamburg, Germany (J.T.N.). 7. University Heart & Vascular Center Hamburg, Hamburg, Germany (F.O., N.A.S., D.W., S.B.). 8. National Taiwan University Hospital, Taipei, Taiwan (K.S., G.H.L., P.T.). 9. McMaster University, Hamilton, Ontario, Canada (P.K., A.W.). 10. Juntendo University Nerima Hospital, Tokyo, Japan (K.I.). 11. University of Oslo and Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway (T.R.J.). 12. Oslo University Hospital, Ullevaal, and University of Oslo, Oslo, Norway (D.A.). 13. University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany (M.A., W.H.). 14. Skåne University Hospital, Lund University, Lund, Sweden (A.M., U.E.). 15. University of Basel, Basel, Switzerland, University Heart and Vascular Center Hamburg, Hamburg, Germany, and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck (R.T.). 16. University of Basel, Basel, Switzerland (C.M.). 17. Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany (P.B.). 18. Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom (N.B., M.D.). 19. Siriraj Hospital, Mahidol University, Bangkok, Thailand (O.R.). 20. Henry Ford Health System, Detroit, Michigan (R.M.N.). 21. Inova Heart and Vascular Institute, Falls Church, Virginia (C.R.D.). 22. Baylor College of Medicine, Houston, Texas (W.F.P.). 23. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts (T.G.N.). 24. Warren Alpert Medical School of Brown University, Providence, Rhode Island (M.A.L.). 25. Harvard School of Public Health, Boston, Massachusetts (W.H.). 26. Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and National Taiwan University, Taipei, Taiwan (K.S.M.). 27. Christchurch Hospital and Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand (M.P.T.). 28. The Centre for Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan (C.L.).
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 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.
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.
Authors: Yader Sandoval; Bradley R Lewis; Ramila A Mehta; Olatunde Ola; Jonathan D Knott; Laura De Michieli; Ashok Akula; Ronstan Lobo; Eric H Yang; S Michael Gharacholou; Marshall Dworak; Erika Crockford; Nicholas Rastas; Eric Grube; Swetha Karturi; Scott Wohlrab; David O Hodge; Tahir Tak; Charles Cagin; Rajiv Gulati; Allan S Jaffe Journal: Circulation Date: 2022-05-10 Impact factor: 39.918
Authors: Kevin Sheng-Kai Ma; Chee-Ming Lee; Po-Hung Chen; Yan Yang; Yi Wei Dong; Yu-Hsun Wang; James Cheng-Chung Wei; Wen Jie Zheng Journal: Front Med (Lausanne) Date: 2022-06-13