Results of the First Patients with Suspected Acute Coronary Syndrome Evaluated with the 1-hour Algorithm Proposed by the European Society of Cardiology

pp. 193-198

Abstract

Background: The European Society of Cardiology (ESC) recommends an algorithm for the evaluation of chest pain with serial measurement of two high sensitivity troponins separated by one hour. However, the high efficacy and safety of the algorithm has only been estimated according to assumptions based on theoretical models. We tested for the first time its performance in the real world by incorporating it into the daily routine of our center.

Methods: This is a prospective, single center study using the ESC 0/1h algorithm with high sensitivity troponin T on unselected patients who presented at the emergency department with suspected non-ST-segment elevation acute myocardial infarction. Efficacy and safety were assessed in terms of the 30-day incidence of acute myocardial infarction, cardiovascular death and the composite of acute myocardial infarction, death or coronary revascularization.

Results: A total of 1,351 patients were included in the study. Mean age was 61±14 years, 12.4% were diabetics and 35.8% had previous history of coronary events. The rate of acute myocardial infarction was 11% and the rate of mortality 0.29%. According to the application of the algorithm, 917 patients were catalogued as “rule out” (67%), 270 as “observe” (20%) and 164 as “rule in” (13%). The rate of acute myocardial infarction was 0.3% in “rule out”, 7% in “observe” and 77.4% in “rule in” (p <0.001). Moreover, death or coronary revascularization was 7.7% in “rule out”, 17.7% in “observe” and 80.4% in “rule in” (p <0.001).

Conclusions: The 1-hour algorithm showed a good capacity to stratify patients presenting with suspicion of acute myocardial infarction and a high negative predictive value to exclude infarction at 30 days, although this capacity decreases when the event considered is the need for coronary revascularization.