Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction.
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Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. / Twerenbold, R; Costabel, JP; Nestelberger, T; Campos, R; Wussler, D; Arbucci, R; Cortes, M; Boeddinghaus, J; Baumgartner, B; Nickel, CH; Bingisser, R; Mueller, C.
in: J AM COLL CARDIOL, Jahrgang 74, Nr. 4, 07.2019, S. 483-494.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction.
AU - Twerenbold, R
AU - Costabel, JP
AU - Nestelberger, T
AU - Campos, R
AU - Wussler, D
AU - Arbucci, R
AU - Cortes, M
AU - Boeddinghaus, J
AU - Baumgartner, B
AU - Nickel, CH
AU - Bingisser, R
AU - Mueller, C
PY - 2019/7
Y1 - 2019/7
N2 - BackgroundThe European Society of Cardiology (ESC) recommends the 0/1-h algorithm for rapid triage of patients with suspected non–ST-segment elevation myocardial infarction (MI). However, its impact on patient management and safety when routinely applied is unknown.ObjectivesThis study sought to determine these important real-world outcome data.MethodsIn a prospective international study enrolling patients presenting with acute chest discomfort to the emergency department (ED), the authors assessed the real-world performance of the ESC 0/1-h algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care and its associated 30-day rates of major adverse cardiac events (MACE) (the composite of cardiovascular death and MI).ResultsAmong 2,296 patients, non–ST-segment elevation MI prevalence was 9.8%. In median, 1-h blood samples were collected 65 min after the 0-h blood draw. Overall, 94% of patients were managed without protocol violations, and 98% of patients triaged toward rule-out did not require additional cardiac investigations including high-sensitivity cardiac troponin T measurements at later time points or coronary computed tomography angiography in the ED. Median ED stay was 2 h and 30 min. The ESC 0/1-h algorithm triaged 62% of patients toward rule-out, and 71% of all patients underwent outpatient management. Proportion of patients with 30-day MACE were 0.2% (95% confidence interval: 03% to 0.5%) in the rule-out group and 0.1% (95% confidence interval: 0% to 0.2%) in outpatients. Very low MACE rates were confirmed in multiple subgroups, including early presenters.ConclusionsThese real-world data document the excellent applicability, short time to ED discharge, and low rate of 30-day MACE associated with the routine clinical use of the ESC 0/1-h algorithm for the management of patients presenting with acute chest discomfort to the ED.
AB - BackgroundThe European Society of Cardiology (ESC) recommends the 0/1-h algorithm for rapid triage of patients with suspected non–ST-segment elevation myocardial infarction (MI). However, its impact on patient management and safety when routinely applied is unknown.ObjectivesThis study sought to determine these important real-world outcome data.MethodsIn a prospective international study enrolling patients presenting with acute chest discomfort to the emergency department (ED), the authors assessed the real-world performance of the ESC 0/1-h algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care and its associated 30-day rates of major adverse cardiac events (MACE) (the composite of cardiovascular death and MI).ResultsAmong 2,296 patients, non–ST-segment elevation MI prevalence was 9.8%. In median, 1-h blood samples were collected 65 min after the 0-h blood draw. Overall, 94% of patients were managed without protocol violations, and 98% of patients triaged toward rule-out did not require additional cardiac investigations including high-sensitivity cardiac troponin T measurements at later time points or coronary computed tomography angiography in the ED. Median ED stay was 2 h and 30 min. The ESC 0/1-h algorithm triaged 62% of patients toward rule-out, and 71% of all patients underwent outpatient management. Proportion of patients with 30-day MACE were 0.2% (95% confidence interval: 03% to 0.5%) in the rule-out group and 0.1% (95% confidence interval: 0% to 0.2%) in outpatients. Very low MACE rates were confirmed in multiple subgroups, including early presenters.ConclusionsThese real-world data document the excellent applicability, short time to ED discharge, and low rate of 30-day MACE associated with the routine clinical use of the ESC 0/1-h algorithm for the management of patients presenting with acute chest discomfort to the ED.
UR - http://europepmc.org/abstract/med/31345421
U2 - 10.1016/j.jacc.2019.05.046
DO - 10.1016/j.jacc.2019.05.046
M3 - SCORING: Journal article
C2 - 31345421
VL - 74
SP - 483
EP - 494
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 4
ER -