Performance of 0/1 h versus 0/3 h pathways in patients with suspected myocardial infarction: a systematic review and individual participant data meta-analysis of randomised controlled trials
Pooled result · Primary safety outcome: all-cause death or new type 1 myocardial infarctionResult — go to the resultRandom-effects pooled OR 0.83 95% CI 0.45–1.53Authors' conclusion
Across the available randomised trials, short-term adverse event rates were low with both pathways, but the pooled safety estimate remained imprecise. On average, earlier cardiac troponin retesting did not reduce emergency department length of stay or clearly increase direct discharge, and substantial between-study heterogeneity indicates that treatment effects might not translate uniformly across health-care systems. For hospitals considering transitioning from a 0/3 h to a 0/1 h pathway, implementation decisions should take broader diagnostic and organisational considerations into account.
Study context
- Population
- Patients with suspected myocardial infarctionpatient presentations, five randomised trials, all of which provided individual participant data
- Participants
- 110,933 patient presentations
- Comparison
- 0/1 h versus 0/3 h pathways
- 0/1 h pathwayn = 55,489
- 0/3 h pathwayn = 55,444
- Outcome
- Primary safety outcome: all-cause death or new type 1 myocardial infarction
- Follow-up
- Within 30 days
Methodological detailstwo-stage random-effects meta-analysis, harmonised outcome definitions, primary safety outcome refined after receipt of individual participant data but before data harmonisation or analysis
- Two-stage random-effects meta-analysis
- Harmonised outcome definitions
- Primary safety outcome refined after receipt of individual participant data but before data harmonisation or analysis
Pooled result
As reported in the abstract
Random-effects pooled OR
0.83
95% CI 0.45–1.53
Events by group
Further pooled results
| Outcome | 0/1 h pathway | 0/3 h pathway | Estimate | |
|---|---|---|---|---|
| Emergency department length of stay (primary efficacy outcome)I2=99.2%; τ2=0.024 | 314 (IQR 211–481) min | 308 (IQR 209–453) min | random-effects pooled geometric mean ratio 1.03 (95% CI 0.85–1.25) | |
| Direct discharge from the emergency department (primary efficacy outcome)I2=97.8%; τ2=0.156 | 67.0% patient presentations | 65.8% patient presentations | random-effects pooled OR for direct discharge 1.31 (95% CI 0.79–2.16) | |
| 0.512Ratio (log scale) |
- Emergency department length of stay (primary efficacy outcome): in four trials emergency department length of stay was not reported for the whole analysis population
Original publication
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