Safety and performance of the ESC 0-1-hour algorithm

By Dr Jonathan Shurlock

STOP-CP, was a prospective observational multicentre study that enrolled 3,181 patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) with the aim to establish the safety and efficacy of high sensitivity cardiac troponin T (hs-cTnT) in this setting.

A subgroup analysis of 1430 participants of the STOP-CP trial (mean age 57.6 ±12.8 years) without ST-segment elevation on presenting ECG was performed. The ESC 0/1-hour algorithm classifies individuals into 3 groups; Rule-in, Observe, and Rule-Out. 178 of 449 (39.6%) individuals with known coronary artery disease (CAD) were classified into the Rule-Out group of which 3.4% had major adverse cardiovascular events (MACE) vs 648 of the 981 (66.1%) of individuals without CAD (p<0.001), of which 1.1% had MACE. Cardiac death or myocardial infarction at 30 days occurred in 183 (12.8%) participants in total

The negative predictive value for MACE did not meet the target threshold of 99% for those with CAD (96.6% [95% CI, 92.8-98.8]) and those without (98.9% [95% CI, 97.8-99.6]) (p=0.04).The ESC 0/1-hour algorithm should be used with caution in those with known CAD as the algorithm performs less well in this group. These findings mirror those of a recent systematic review.

These findings have implications for acute clinicians and emergency departments who frequently manage the risk of patients presenting with suspected ACS, particularly in the context of ever busier departments.

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