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.

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.

• Authors: Cho-Han Chiang, Cho-Hung Chiang, John W Pickering, Kiril M Stoyanov, Derek P Chew, Johannes T Neumann, Francisco Ojeda, Nils A Sörensen, Ke-Ying Su, Peter Kavsak, Andrew Worster, Kenji Inoue, Tonje R Johannessen, Dan Atar, Michael Amann, Willibald Hochholzer, Arash Mokhtari, Ulf Ekelund, Raphael Twerenbold, Christian Mueller, Philipp Bahrmann, Nicolas Buttinger, Maureen Dooley, Onlak Ruangsomboon, Richard M Nowak, Christopher R DeFilippi, William F Peacock, Tomas G Neilan, Michael A Liu, Wan-Ting Hsu, Gin Hoong Lee, Pui-Un Tang, Kevin Sheng-Kai Ma, Dirk Westermann, Stefan Blankenberg, Evangelos Giannitsis, Martin P Than, Chien-Chang Lee
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 175 Issue 1 Pg. 101-113 (01 2022) ISSN: 1539-3704 [Electronic] United States
• PMID: 34807719 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Troponin

Topics

• 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)