Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: Systematic review and meta-analysis
Journal
Heart
Journal Volume
106
Journal Issue
13
Pages
985-991
Date Issued
2020
Author(s)
Abstract
Objective The European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 hour algorithm across different contexts. Methods We searched PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome. Results A total of 11 014 patients from 10 cohorts were analysed for the primary outcome. The algorithm based on high-sensitivity cardiac troponin (hs-cTn)T (Roche), hs-cTnI (Abbott) and hs-cTnI (Siemens) had pooled sensitivity of 98.4% (95% CI=95.1% to 99.5%), 98.1% (95% CI=94.6% to 99.3%) and 98.7% (95% CI=97.3% to 99.3%), respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% (95% CI=86.0% to 94.6%) and 95.9% (95% CI=94.1% to 97.2%), respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% (95% CI=0.0% to 0.4%) and 0.8% (95% CI=0.5% to 1.2%), respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% (95% CI=0.3% to 1.2%) at 30 days but increased to 8.1% (95% CI=6.1% to 10.4%) at 1 year, comparable to the mortality rate in the rule-in group. Conclusion The ESC 0/1 hour algorithm has high diagnostic accuracy but may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired. PROSPERO registration number CRD42019142280. ? Author(s) (or their employer(s)) 2020.
Subjects
acute coronary syndromes; acute myocardial infarction
SDGs
Other Subjects
troponin I; troponin T; biological marker; troponin I; troponin T; algorithm; Australia and New Zealand; cardiovascular mortality; clinical effectiveness; Europe; heart infarction; human; major adverse cardiac event; meta analysis; mortality rate; outcome assessment; patient safety; priority journal; publication; Review; sensitivity and specificity; systematic review; validation process; Western Hemisphere; aged; blood; clinical decision making; female; heart infarction; male; middle aged; mortality; predictive value; prognosis; risk assessment; time factor; Aged; Algorithms; Biomarkers; Clinical Decision Rules; Clinical Decision-Making; Female; Heart Disease Risk Factors; Humans; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Prognosis; Risk Assessment; Time Factors; Troponin I; Troponin T
Type
review