Direct Comparison of the European Society of Cardiology 0/1-Hour Vs. 0/2-Hour Algorithms in Patients with Acute Chest Pain.
J Emerg Med
; 66(6): e651-e659, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38789353
ABSTRACT
BACKGROUND:
The recent guidelines from the European Society of Cardiology recommends using high-sensitivity cardiac troponin (hs-cTn) in either 0/1-h or 0/2-h algorithms to identify or rule out acute myocardial infarction (AMI). Several studies have reported good diagnostic accuracy with both algorithms, but few have compared the algorithms directly.OBJECTIVE:
We aimed to compare the diagnostic accuracy of the algorithms head-to-head, in the same patients.METHODS:
This was a secondary analysis of data from a prospective observational study; 1167 consecutive patients presenting with chest pain to the emergency department at Skåne University Hospital (Lund, Sweden) were enrolled. Only patients with a hs-cTnT sample at presentation AND after 1 AND 2 h were included in the analysis. We compared sensitivity, specificity, and negative (NPV) and positive predictive value (PPV). The primary outcome was index visit AMI.RESULTS:
A total of 710 patients were included, of whom 56 (7.9%) had AMI. Both algorithms had a sensitivity of 98.2% and an NPV of 99.8% for ruling out AMI, but the 0/2-h algorithm ruled out significantly more patients (69.3% vs. 66.2%, p < 0.001). For rule-in, the 0/2-h algorithm had higher PPV (73.4% vs. 65.2%) and slightly better specificity (97.4% vs. 96.3%, p = 0.016) than the 0/1-h algorithm.CONCLUSION:
Both algorithms had good diagnostic accuracy, with a slight advantage for the 0/2-h algorithm. Which algorithm to implement may thus depend on practical issues such as the ability to exploit the theoretical time saved with the 0/1-h algorithm. Further studies comparing the algorithms in combination with electrocardiography, history, or risk scores are needed.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Algoritmos
/
Dor no Peito
/
Serviço Hospitalar de Emergência
/
Infarto do Miocárdio
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article