Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T
Authors' conclusion
The 0/1/3 h algorithm shows excellent diagnostic safety and adds prognostic value, with delayed rule-out associated with significantly increased long-term cardiovascular risk and mortality.
Study context
- Population
- Patients presenting to the emergency department with suspected myocardial infarction (MI)median age 64 years, 63.6% men
- Participants
- 2,514 patients
- Exposure
- Cox regression analyses compared cardiovascular risk at 90 days and 3 years between rule-in and rule-out groups
Methodological detailsprospectively enrolled, external validation
- Prospectively enrolled
- External validation
Main finding
As reported in the abstract
Diagnostic accuracy of the 0/1/3 h algorithm
Sensitivity
98.6%
95% CI 96.8, 99.4
NPV
99.7%
99.2, 99.9
Specificity
89.3%
87.9, 90.5
PPV
60.8%
56.8, 64.7
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| MACE and mortality risk — ruled-out at 3 h vs immediate rule-out · MACE; doubled risk | 2.11 (1.44–3.08) | P < 0.001 | |
| MACE and mortality risk — ruled-out at 3 h vs immediate rule-out · mortality; quadrupled risk | 4.33 (1.85–10.12) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
MACE and deaths · Over 3 years
- Patients experienced MACE
- 646
- Died
- 256
- Cardiac deaths
- 68
Original publication
Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T. Eur Heart J Qual Care Clin Outcomes. Published 21 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it