Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis.

Autor:	Chiang CH; Harvard Medical School, Boston, Massachusetts, and National Taiwan University College of Medicine, Taipei, Taiwan (Cho-Han Chiang)., Chiang CH; Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan (Cho-Hung Chiang)., Pickering JW; Christchurch Hospital and University of Otago Christchurch, Christchurch, New Zealand (J.W.P.)., Stoyanov KM; University Hospital of Heidelberg, Heidelberg, Germany (K.M.S., E.G.)., Chew DP; Flinders University of South Australia, Adelaide, Australia (D.P.C.)., Neumann JT; Monash University, Melbourne, Australia, and University Heart & Vascular Center Hamburg, Hamburg, Germany (J.T.N.)., Ojeda F; University Heart & Vascular Center Hamburg, Hamburg, Germany (F.O., N.A.S., D.W., S.B.)., Sörensen NA; University Heart & Vascular Center Hamburg, Hamburg, Germany (F.O., N.A.S., D.W., S.B.)., Su KY; National Taiwan University Hospital, Taipei, Taiwan (K.S., G.H.L., P.T.)., Kavsak P; McMaster University, Hamilton, Ontario, Canada (P.K., A.W.)., Worster A; McMaster University, Hamilton, Ontario, Canada (P.K., A.W.)., Inoue K; Juntendo University Nerima Hospital, Tokyo, Japan (K.I.)., Johannessen TR; University of Oslo and Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway (T.R.J.)., Atar D; Oslo University Hospital, Ullevaal, and University of Oslo, Oslo, Norway (D.A.)., Amann M; University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany (M.A., W.H.)., Hochholzer W; University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany (M.A., W.H.)., Mokhtari A; Skåne University Hospital, Lund University, Lund, Sweden (A.M., U.E.)., Ekelund U; Skåne University Hospital, Lund University, Lund, Sweden (A.M., U.E.)., Twerenbold R; University of Basel, Basel, Switzerland, University Heart and Vascular Center Hamburg, Hamburg, Germany, and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck (R.T.)., Mueller C; University of Basel, Basel, Switzerland (C.M.)., Bahrmann P; Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany (P.B.)., Buttinger N; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom (N.B., M.D.)., Dooley M; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom (N.B., M.D.)., Ruangsomboon O; Siriraj Hospital, Mahidol University, Bangkok, Thailand (O.R.)., Nowak RM; Henry Ford Health System, Detroit, Michigan (R.M.N.)., DeFilippi CR; Inova Heart and Vascular Institute, Falls Church, Virginia (C.R.D.)., Peacock WF; Baylor College of Medicine, Houston, Texas (W.F.P.)., Neilan TG; Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts (T.G.N.)., Liu MA; Warren Alpert Medical School of Brown University, Providence, Rhode Island (M.A.L.)., Hsu WT; Harvard School of Public Health, Boston, Massachusetts (W.H.)., Lee GH; National Taiwan University Hospital, Taipei, Taiwan (K.S., G.H.L., P.T.)., Tang PU; National Taiwan University Hospital, Taipei, Taiwan (K.S., G.H.L., P.T.)., Ma KS; Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and National Taiwan University, Taipei, Taiwan (K.S.M.)., Westermann D; University Heart & Vascular Center Hamburg, Hamburg, Germany (F.O., N.A.S., D.W., S.B.)., Blankenberg S; University Heart & Vascular Center Hamburg, Hamburg, Germany (F.O., N.A.S., D.W., S.B.)., Giannitsis E; University Hospital of Heidelberg, Heidelberg, Germany (K.M.S., E.G.)., Than MP; Christchurch Hospital and Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand (M.P.T.)., Lee CC; The Centre for Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan (C.L.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2022 Jan; Vol. 175 (1), pp. 101-113. Date of Electronic Publication: 2021 Nov 23.
DOI:	10.7326/M21-1499
Abstrakt:	Background: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI). Purpose: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms. Data Sources: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479). Study Selection: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI. Data Extraction: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality. Data Synthesis: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays. Limitation: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies. Conclusion: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI. Primary Funding Source: National Taiwan University Hospital.
Databáze:	MEDLINE
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