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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
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
4664931
Author(s)
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
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
Journal
Annals of Internal Medicine
Volume
175
Number
1
Pages / Article-Number
101-113
Mesh terms
Algorithms; Biomarkers, blood; Diagnosis, Differential; Europe; Humans; Myocardial Infarction, diagnosis; Practice Guidelines as Topic; Predictive Value of Tests; Reproducibility of Results; Risk Factors; Societies, Medical; Time Factors; Triage, methods; Troponin, blood
Abstract
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).; To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms.; PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479).; Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI.; 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.; 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.; Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies.; The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI.; National Taiwan University Hospital.
