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Real-world outcome data of the European Society of Cardiology 0/1-hour algorithm for rapid triage of suspected myocardial infarction

Session Poster Session 1

Speaker Raphael Twerenbold

Event : ESC Congress 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Biomarkers
  • Session type : Poster Session

Authors : R Twerenbold (Basel,CH), JP Costabel (Buenos Aires,AR), R Campos (Buenos Aires,AR), R Arbucci (Buenos Aires,AR), T Nestelberger (Basel,CH), J Boeddinghaus (Basel,CH), P Badertscher (Basel,CH), M Rubini Gimenez (Basel,CH), D Wussler (Basel,CH), S Osswald (Basel,CH), T Reichlin (Basel,CH), F Lambardi (Buenos Aires,AR), S Resi (Buenos Aires,AR), M Trivi (Buenos Aires,AR), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , J.P. Costabel2 , R. Campos2 , R. Arbucci2 , T. Nestelberger1 , J. Boeddinghaus1 , P. Badertscher1 , M. Rubini Gimenez1 , D. Wussler1 , S. Osswald1 , T. Reichlin1 , F. Lambardi2 , S. Resi2 , M. Trivi2 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland , 2Instituto Cardiovascular de Buenos Aires - Buenos Aires - Argentina ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 147-148

Background: The European Society of Cardiology (ESC) recommends a 0/1h-algorithm using high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST-segment myocardial infarction (NSTEMI). However, high efficacy and safety have only been estimated based on theoretical model-based assumptions.

Purpose: We aimed to assess for the first time the real-world performance of the ESC 0/1h-algorithm when embedded in clinical routine.

Methods: In a prospective multicenter study enrolling unselected patients presenting with suspected NSTEMI to the emergency department (ED) of two tertiary hospitals in Switzerland and Argentina, we assessed the efficacy and safety of the ESC 0/1h-algorithm using hs-cTnT embedded in routine clinical care. ST-segment elevation myocardial infarctions were excluded. Efficacy was quantified as the proportion of patients assigned to either rule-out or rule-in by the 0/1h-algorithm as well as the proportion undergoing outpatient management. Safety was quantified as the 30-day incidence of major adverse cardiac event (MACE, the composite of cardiovascular death and myocardial infarction including the index event) in the rule-out group and in outpatients.

Results: Among 2296 recruited patients, prevalence of NSTEMI was 9.8%. The ESC 0/1h-algorithm assigned 62% (1420/2296) of patients to the rule-out and 13% (295/2296) to the rule-in group. Median time to discharge from the ED was 150 [134,235] minutes. Overall, 71% (1619/2296) of patients underwent outpatient management. Safety of rule-out and outpatient management were very high with a 30-day MACE incidence of 0.2% and 0.1%, respectively. Multiple predefined subgroup analyses confirmed high safety.

Conclusion: These real-world data document for the first time the excellent efficacy and safety of the ESC 0/1h-algorithm for the rapid management of patients with suspected NSTEMI.

Figure 1

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