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Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis

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Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis. / Chiang, Cho-Han; Chiang, Cho-Hung; Pickering, John W; Stoyanov, Kiril M; Chew, Derek P; Neumann, Johannes T; Ojeda, Francisco; Sörensen, Nils A; Su, Ke-Ying; Kavsak, Peter; Worster, Andrew; Inoue, Kenji; Johannessen, Tonje R; Atar, Dan; Amann, Michael; Hochholzer, Willibald; Mokhtari, Arash; Ekelund, Ulf; Twerenbold, Raphael; Mueller, Christian; Bahrmann, Philipp; Buttinger, Nicolas; Dooley, Maureen; Ruangsomboon, Onlak; Nowak, Richard M; DeFilippi, Christopher R; Peacock, William F; Neilan, Tomas G; Liu, Michael A; Hsu, Wan-Ting; Lee, Gin Hoong; Tang, Pui-Un; Ma, Kevin Sheng-Kai; Westermann, Dirk; Blankenberg, Stefan; Giannitsis, Evangelos; Than, Martin P; Lee, Chien-Chang.

In: ANN INTERN MED, Vol. 175, No. 1, 01.2022, p. 101-113.

Research output: SCORING: Contribution to journal › SCORING: Review article › Research

Harvard

Chiang, C-H, Chiang, C-H, Pickering, JW, Stoyanov, KM, Chew, DP, Neumann, JT, Ojeda, F, Sörensen, NA, Su, K-Y, Kavsak, P, Worster, A, Inoue, K, Johannessen, TR, Atar, D, Amann, M, Hochholzer, W, Mokhtari, A, Ekelund, U, Twerenbold, R, Mueller, C, Bahrmann, P, Buttinger, N, Dooley, M, Ruangsomboon, O, Nowak, RM, DeFilippi, CR, Peacock, WF, Neilan, TG, Liu, MA, Hsu, W-T, Lee, GH, Tang, P-U, Ma, KS-K, Westermann, D, Blankenberg, S, Giannitsis, E, Than, MP & Lee, C-C 2022, 'Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis', ANN INTERN MED, vol. 175, no. 1, pp. 101-113. https://doi.org/10.7326/M21-1499

APA

Chiang, C-H., Chiang, C-H., Pickering, J. W., Stoyanov, K. M., Chew, D. P., Neumann, J. T., Ojeda, F., Sörensen, N. A., Su, K-Y., Kavsak, P., Worster, A., Inoue, K., Johannessen, T. R., Atar, D., Amann, M., Hochholzer, W., Mokhtari, A., Ekelund, U., Twerenbold, R., ... Lee, C-C. (2022). Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis. ANN INTERN MED, 175(1), 101-113. https://doi.org/10.7326/M21-1499

Vancouver

Chiang C-H, Chiang C-H, Pickering JW, Stoyanov KM, Chew DP, Neumann JT et al. Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis. ANN INTERN MED. 2022 Jan;175(1):101-113. https://doi.org/10.7326/M21-1499

Bibtex

@article{69c89f5330e144178e16331529b13fde,
title = "Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis",
abstract = "BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.DATA EXTRACTION: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.DATA SYNTHESIS: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.LIMITATION: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.CONCLUSION: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.PRIMARY FUNDING SOURCE: National Taiwan University Hospital.",
author = "Cho-Han Chiang and Cho-Hung Chiang and Pickering, {John W} and Stoyanov, {Kiril M} and Chew, {Derek P} and Neumann, {Johannes T} and Francisco Ojeda and S{\"o}rensen, {Nils A} and Ke-Ying Su and Peter Kavsak and Andrew Worster and Kenji Inoue and Johannessen, {Tonje R} and Dan Atar and Michael Amann and Willibald Hochholzer and Arash Mokhtari and Ulf Ekelund and Raphael Twerenbold and Christian Mueller and Philipp Bahrmann and Nicolas Buttinger and Maureen Dooley and Onlak Ruangsomboon and Nowak, {Richard M} and DeFilippi, {Christopher R} and Peacock, {William F} and Neilan, {Tomas G} and Liu, {Michael A} and Wan-Ting Hsu and Lee, {Gin Hoong} and Pui-Un Tang and Ma, {Kevin Sheng-Kai} and Dirk Westermann and Stefan Blankenberg and Evangelos Giannitsis and Than, {Martin P} and Chien-Chang Lee",
year = "2022",
month = jan,
doi = "10.7326/M21-1499",
language = "English",
volume = "175",
pages = "101--113",
journal = "ANN INTERN MED",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "1",

}

RIS

TY - JOUR

T1 - Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis

AU - Chiang, Cho-Han

AU - Chiang, Cho-Hung

AU - Pickering, John W

AU - Stoyanov, Kiril M

AU - Chew, Derek P

AU - Neumann, Johannes T

AU - Ojeda, Francisco

AU - Sörensen, Nils A

AU - Su, Ke-Ying

AU - Kavsak, Peter

AU - Worster, Andrew

AU - Inoue, Kenji

AU - Johannessen, Tonje R

AU - Atar, Dan

AU - Amann, Michael

AU - Hochholzer, Willibald

AU - Mokhtari, Arash

AU - Ekelund, Ulf

AU - Twerenbold, Raphael

AU - Mueller, Christian

AU - Bahrmann, Philipp

AU - Buttinger, Nicolas

AU - Dooley, Maureen

AU - Ruangsomboon, Onlak

AU - Nowak, Richard M

AU - DeFilippi, Christopher R

AU - Peacock, William F

AU - Neilan, Tomas G

AU - Liu, Michael A

AU - Hsu, Wan-Ting

AU - Lee, Gin Hoong

AU - Tang, Pui-Un

AU - Ma, Kevin Sheng-Kai

AU - Westermann, Dirk

AU - Blankenberg, Stefan

AU - Giannitsis, Evangelos

AU - Than, Martin P

AU - Lee, Chien-Chang

PY - 2022/1

Y1 - 2022/1

N2 - BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.DATA EXTRACTION: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.DATA SYNTHESIS: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.LIMITATION: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.CONCLUSION: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.PRIMARY FUNDING SOURCE: National Taiwan University Hospital.

AB - BACKGROUND: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI).PURPOSE: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).STUDY SELECTION: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.DATA EXTRACTION: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality.DATA SYNTHESIS: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays.LIMITATION: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.CONCLUSION: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.PRIMARY FUNDING SOURCE: National Taiwan University Hospital.

U2 - 10.7326/M21-1499

DO - 10.7326/M21-1499

M3 - SCORING: Review article

C2 - 34807719

VL - 175

SP - 101

EP - 113

JO - ANN INTERN MED

JF - ANN INTERN MED

SN - 0003-4819

IS - 1

ER -