P1735Direct comparison of the 0/1h- and 0/3h-algorithm for early rule-out of acute myocardial infarction
Patrick Badertscher, Jasper Boeddinghaus, Raphael Twerenbold, Thomas Nestelberger, Desiree Nadine Wussler, Christian Puelacher, María Rubini Giménez, Nikola Kozhuharov, Jeanne du Fay de Lavallaz, Òscar Miró, J Martin-Sanchez, Beata Morawiec, Tobias Reichlin, Christian Eugen Mueller · European Heart Journal · 2018
Background: The 0/1h-algorithm and the 0/3h-algorithm are both recommended by the European Society of Cardiology (ESC) with a class I recommendation for the early rule-out of acute myocardial infarction (AMI). We aimed to directly assess and compare their safety and efficacy. Methods: Among patients presenting with acute chest discomfort to the emergency department, classification towards rule-out by the 0/1h-algorithm or the 0/3h-algorithm were compared against the final adjudication performed by two independent cardiologists using all information including cardiac imaging and serial hs-cTnT measurements. Analyses were performed using high-sensitivity cardiac troponin (hs-cTn) T and hs-cTnI. Safety, as quantified by the negative predictive value (NPV), and efficacy of rule-out were the co-primary endpoints. Results: Among 2547 patients eligible for analysis using hs-cTnT, AMI was the final adjudicated diagnosis in 387 patients (15%). The 0/1h-algorithm provided similar safety (NPV 99.8% (95% CI 99.4–99.9%) versus 99.7% (95% CI 99.2–99.9%), p=0.645) and higher efficacy as compared to the 0/3h-algorithm (60% (95% CI 58–62%) versus 44% (95% CI 42–46%), p<0.001). Among 2197 patients eligible for analysis using hs-cTnI, AMI was the final diagnosis in 327 patients (15%). The 0/1h-algorithm provided higher safety (NPV 99.6% (95% CI 99.1–99.9%) versus 97.8 (95% CI 96.7–98.5%), p<0.001) and similar efficacy compared to the 0/3h-algorithm (52% (95% CI 50–54%) versus 51% (95% CI 49–53%), p=0.507, Figure 1). These findings were confirmed in the subgroup of early presenters, and in a second adjudication using serial hs-cTnI measurements.