Coronary disease & ACSRandomised controlled trial
Accelerated Diagnostic Pathways for Suspected Acute Coronary Syndrome in Practice
- Randomised controlled trial
- pragmatic
- noninferiority
- implementation trial
Authors' conclusion
Implementation of the ESC 0/1-hour pathway failed to discharge significantly more patients within 4 hours of presentation compared with the 0/3-hour ADP. In addition, The ESC 0/1-hour was noninferior to the 0/3-hour hs-cTn pathway for safety of discharge, although safety for both pathways was less than that imputed by observational studies.
Study context
- Population
- Patients with suspected acute coronary syndrome (ACS) at 2 major EDs in North-West England, December 2021 to July 202413,983 screened
- Participants
- 3,543 patients
- Comparison
- European Society of Cardiology (ESC) 0/1-hour vs 0/3-hour hs-cTn accelerated diagnostic pathway
- Primary endpoint
- Efficiency: proportion discharged within 4 hours; safety: MACE (adjudicated index or representation type 1 myocardial infarction (MI), CV death, urgent coronary revascularization) in those discharged as not ACS
- Follow-up
- Within 30 days
Primary result
As reported in the abstract
Proportion discharged within 4 hours
Proportion discharged within 4 h relatively low and did not differ substantially (21.8% vs 19.2%)
P = 0.07
Safety
| Outcome | 0/1-hour | 0/3-hour | absolute difference in sensitivity (1-sided 97.5% CI) |
|---|---|---|---|
| Sensitivity for 30-day MACE in discharged patients · within 30 days · noninferior | 93.7% (95% CI 88.4%–97.1%) | 89.5% (95% CI 82.7%–94.3%) | +4.2% (−2.5) |
- Sensitivity for 30-day major adverse cardiac events (MACE) in discharged patients: noninferiority margin 3%
- Sensitivity for 30-day MACE in discharged patients: 1-sided 97.5% CI
Original publication
Accelerated Diagnostic Pathways for Suspected Acute Coronary Syndrome in Practice. J Am Coll Cardiol. Published 20 May 2026. doi:10.1016/j.jacc.2026.02.5135
Summarised from the published abstract; every number is checked against it