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
Issued Date
2022-01-01
Resource Type
ISSN
00034819
eISSN
15393704
DOI
Scopus ID
2-s2.0-85122892707
Pubmed ID
34807719
Journal Title
Annals of Internal Medicine
Volume
175
Issue
1
Start Page
101
End Page
113
Rights Holder(s)
SCOPUS
Bibliographic Citation
Annals of Internal Medicine Vol.175 No.1 (2022) , 101-113
Suggested Citation
Chiang C.H. 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. Annals of Internal Medicine Vol.175 No.1 (2022) , 101-113. 113. doi:10.7326/M21-1499 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86703
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
Author(s)
Author's Affiliation
University Hospitals Sussex NHS Foundation Trust
Siriraj Hospital
Universitäre Herz- und Gefäßzentrum UKE Hamburg GmbH
Deutsches Zentrum für Herz-Kreislauf-Forschung e. V.
Oslo Universitetssykehus
National Taiwan University Hospital
Harvard T.H. Chan School of Public Health
Juntendo University
McMaster University
Henry Ford Health System
Massachusetts General Hospital
Inova Heart and Vascular Institute
National Taiwan University College of Medicine
Universitat Basel
Flinders University
Monash University
Universitäts Herzzentrum Freiburg Bad Krozingen
Skånes universitetssjukhus
Universitetet i Oslo
The Warren Alpert Medical School
National Taiwan University
University of Pennsylvania Perelman School of Medicine
Universitätsklinikum Heidelberg
Harvard Medical School
Baylor College of Medicine
University of Otago, Christchurch
Friedrich-Alexander-Universität Erlangen-Nürnberg
Buddhist Tzu Chi Medical Foundation
Siriraj Hospital
Universitäre Herz- und Gefäßzentrum UKE Hamburg GmbH
Deutsches Zentrum für Herz-Kreislauf-Forschung e. V.
Oslo Universitetssykehus
National Taiwan University Hospital
Harvard T.H. Chan School of Public Health
Juntendo University
McMaster University
Henry Ford Health System
Massachusetts General Hospital
Inova Heart and Vascular Institute
National Taiwan University College of Medicine
Universitat Basel
Flinders University
Monash University
Universitäts Herzzentrum Freiburg Bad Krozingen
Skånes universitetssjukhus
Universitetet i Oslo
The Warren Alpert Medical School
National Taiwan University
University of Pennsylvania Perelman School of Medicine
Universitätsklinikum Heidelberg
Harvard Medical School
Baylor College of Medicine
University of Otago, Christchurch
Friedrich-Alexander-Universität Erlangen-Nürnberg
Buddhist Tzu Chi Medical Foundation
Other Contributor(s)
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.