Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction
Authors' conclusion
The sensitivity of the European Society of Cardiology rapid assessment 0-/1-hour algorithm to rule-out AMI with high-sensitivity troponin may be insufficient for some emergency department physicians to confidently send patients home.
Study context
- Population
- ED patients with chest pain investigated for possible ACS, hospitals in New Zealand, Australia and Canadaserial hs-TnT and hs-TnI
- Participants
- 2,222 patients
- Comparison
- ESC 0/1-h algorithm with hs-troponin T vs hs-troponin I
- Outcome
- Adjudicated AMI: sensitivity and proportion ruled out; PPV and proportion ruled in
Methodological detailsmulticentre, acute myocardial infarction (AMI) outcomes independently adjudicated by at least 2 physicians
- Multicentre
- AMI outcomes independently adjudicated by at least 2 physicians
Performance
As reported in the abstract
| Test or model | Ruled out | Sensitivity | Ruled in | PPV |
|---|---|---|---|---|
| hs-TnT algorithm | 1425 (64.1%) | 97.1% (95% CI, 94.0%-98.8%) | 292 (13.1%) | 63.4% (95% CI, 57.5%-68.9%) |
| hs-TnI algorithm | 1205 (54.2%) | 98.8% (95% CI, 96.4%-99.7%) | 310 (14.0%) | 68.1% (95% CI, 62.6%-73.2%) |
Ruled out
hs-TnT algorithm1425 (64.1%)
hs-TnI algorithm1205 (54.2%)
Sensitivity
hs-TnT algorithm97.1% (95% CI, 94.0%-98.8%)
hs-TnI algorithm98.8% (95% CI, 96.4%-99.7%)
Ruled in
hs-TnT algorithm292 (13.1%)
hs-TnI algorithm310 (14.0%)
PPV
hs-TnT algorithm63.4% (95% CI, 57.5%-68.9%)
hs-TnI algorithm68.1% (95% CI, 62.6%-73.2%)
Original publication
Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction. Circulation. Published 17 October 2016. doi:10.
Summarised from the published abstract; every number is checked against it