Implementing the European Society of Cardiology 0-h/1-h algorithm in patients presenting very early after chest pain
Journal
International Journal of Cardiology
Journal Volume
320
Pages
1-6
Date Issued
2020
Author(s)
Shiozaki M.
Inoue K.
Suwa S.
Chiang S.-J.
Sato A.
Shimizu M.
Fukuda K.
Hiki M.
Kubota N.
Tamura H.
Fujiwara Y.
Ouchi S.
Miyazaki T.
Hirano Y.
Tanaka H.
Sugita M.
Nakazato Y.
Sumiyoshi M.
Daida H.
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. ? 2020 Elsevier B.V.
SDGs
Other Subjects
acute heart infarction; aged; algorithm; Article; cardiology; cardiovascular mortality; cohort analysis; controlled study; emergency ward; female; heart death; hospital; human; major adverse cardiac event; major clinical study; male; medical society; prevalence; priority journal; prospective study; thorax pain; algorithm; clinical trial; hospital emergency service; multicenter study; thorax pain; biological marker; troponin T; Algorithms; Biomarkers; Cardiology; Chest Pain; Cohort Studies; Emergency Service, Hospital; Humans; Prospective Studies; Troponin T
Type
journal article