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

Juan Pablo Costabel, Roberto Campos, Paula Ariznavarreta, Florencia Lambardi, Rosina Arbucci, Marcia Cortes, Juan Manuel Vergara, Maite Borda, Alberto Alves de Lima, Marcelo Trivi

Abstract


Background: The European Society of Cardiology (ESC) recommends an algorithm for the evaluation of chest pain with serialmeasurement of two high sensitivity troponins separated by one hour. However, the high efficacy and safety of the algorithmhas only been estimated according to assumptions based on theoretical models. We tested for the first time its performancein 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 unselectedpatients 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 andthe 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% hadprevious history of coronary events. The rate of acute myocardial infarction was 11% and the rate of mortality 0.29%. Accordingto the application of the algorithm, 917 patients were catalogued as “rule out” (67%), 270 as “observe” (20%) and 164 as “rulein” (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 myocardialinfarction and a high negative predictive value to exclude infarction at 30 days, although this capacity decreases when theevent considered is the need for coronary revascularization.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar