Coronary disease & ACSRandomised controlled trial
Safety and efficacy of the 0/1 h pathway for myocardial infarction in the emergency department: an international, pragmatic, stepped-wedge, cluster-randomised, controlled trial
- Stepped-wedge cluster-randomised controlled trial
- international
- pragmatic
- masked-endpoint
- non-inferiority (safety)
- superiority (efficacy)
- 19 hospitals in ten countries
Authors' conclusion
Implementation of the 0/1 h pathway met the prespecified non-inferiority criterion for the 30-day composite safety outcome but did not shorten emergency department length of stay compared with the 0/3 h pathway.
Study context
- Population
- Consecutive adults presenting to the ED with acute non-traumatic chest discomfort and suspected MI
- Participants
- 67,624 patient presentations
- Comparison
- 0/1 h vs 0/3 h high-sensitivity cardiac troponin pathway
- 0/1 hn = 31,160
- 0/3 hn = 36,464reference
- Primary endpoint
- Coprimary: safety = death from any cause or new type 1 MI within 30 days; efficacy = ED length of stay
- Follow-up
- 30 days (safety)
Primary result
As reported in the abstract
0/1 h vs 0/3 hAdjusted odds ratio (95% CI)P value
death or new type 1 MI at 30 days
0.93(0.77–1.13)
P = 0.0004for non-inferiority- ED length of stay
- ratio of adjusted median times 1.00 (95% CI 0.97–1.02); two-sided p=0.65
Original publication
Safety and efficacy of the 0/1 h pathway for myocardial infarction in the emergency department: an international, pragmatic, stepped-wedge, cluster-randomised, controlled trial. Lancet. Published 29 August 2026. doi:10.1016/s0140-6736(26)01654-5
Summarised from the published abstract; every number is checked against it