Comparison of the European Society of Cardiology 0/1-Hour and High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome 0/2-or-0/3-Hour Algorithms for Rapid Myocardial Infarction Diagnosis: A Prospective Multicenter Study
Authors' conclusion
Overall, both algorithms exhibited comparable and excellent performance. When using hs-cTnI, the ESC-0/1h-algorithms showed higher sensitivity, whereas the High-STEACS 0/2h-0/3h-pathways demonstrated higher efficacy. Consistently, the ESC 0/1h-algorithms showed higher specificity for NSTEMI.
Study context
- Population
- Patients presenting to the ED with acute chest discomfort; 3 high-sensitivity cardiac troponin (hs-cTn) assays (hs-cTnI-Architect, hs-cTnI-Centaur/Atellica, hs-cTnT-Elecsys)663 (14.2%) NSTEMI type 1
- Participants
- 4,663 patients
- Comparison
- ESC 0/1h-algorithm vs High-STEACS 0/2h-0/3h-pathway
- Outcome
- NSTEMI type 1
Methodological detailsprospective, international, multicentre, central adjudication, external validation, Final diagnoses centrally adjudicated by 2 independent cardiologists
- Prospective
- International
- Multicentre
- Central adjudication
- External validation
- Final diagnoses centrally adjudicated by 2 independent cardiologists
Performance
As reported in the abstract
NSTEMI type 1 (hs-cTnI-Architect)
| Test or model | Sensitivity | Ruled out | Sensitivity (0/2h) | Ruled out (0/2h) |
|---|---|---|---|---|
| ESC 0/1h-algorithm | 100% (95% CI: 99.4-100) | 52% | ||
| High-STEACS 0/2h-0/3h-pathway | 98.1% (95% CI: 96.7-99) | 72.5% |
Sensitivity
ESC 0/1h-algorithm100% (95% CI: 99.4-100)
High-STEACS 0/2h-0/3h-pathwayNot reported in the abstract
Ruled out
ESC 0/1h-algorithm52%
High-STEACS 0/2h-0/3h-pathwayNot reported in the abstract
Sensitivity (0/2h)
ESC 0/1h-algorithmNot reported in the abstract
High-STEACS 0/2h-0/3h-pathway98.1% (95% CI: 96.7-99)
Ruled out (0/2h)
ESC 0/1h-algorithmNot reported in the abstract
High-STEACS 0/2h-0/3h-pathway72.5%
- ESC 0/1h-algorithm vs High-STEACS 0/2h-0/3h-pathway: P < 0.001 — sensitivity, hs-cTnI-Architect
- ESC 0/1h-algorithm vs High-STEACS 0/2h-0/3h-pathway: P < 0.001 — proportion ruled out, hs-cTnI-Architect
Further findings
High-STEACS 0/3h-pathways and external validation cohort
- Findings confirmed with 0/3h-pathways and in external validation cohort (n = 2,485)
Original publication
Comparison of the European Society of Cardiology 0/1-Hour and High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome 0/2-or-0/3-Hour Algorithms for Rapid Myocardial Infarction Diagnosis: A Prospective Multicenter Study. J Am Coll Cardiol. Published 18 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it