Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction

Twerenbold, Raphael and Costabel, Juan Pablo and Nestelberger, Thomas and Campos, Roberto and Wussler, Desiree and Arbucci, Rosina and Cortes, Marcia and Boeddinghaus, Jasper and Baumgartner, Benjamin and Nickel, Christian H. and Bingisser, Roland and Badertscher, Patrick and Puelacher, Christian and du Fay de Lavallaz, Jeanne and Wildi, Karin and Rubini Giménez, Maria and Walter, Joan and Meier, Mario and Hafner, Benjamin and Lopez Ayala, Pedro and Lohrmann, Jens and Troester, Valentina and Koechlin, Luca and Zimmermann, Tobias and Gualandro, Danielle M. and Reichlin, Tobias and Lambardi, Florencia and Resi, Silvana and Alves de Lima, Alberto and Trivi, Marcelo and Mueller, Christian. (2019) Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. Journal of the American College of Cardiology, 74 (4). pp. 483-494.

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Official URL: https://edoc.unibas.ch/77021/

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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.; This study sought to determine these important real-world outcome data.; 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).; 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.; 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.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Twerenbold, Raphael and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:American College of Cardiology
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:28 Sep 2020 09:17
Deposited On:19 Aug 2020 07:09

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