A SINGLE CENTRE PROSPECTIVE STUDY COMPARING THE 0/1H AND 0/3H RULE OUT/RULE IN ALGORITHMS FOR MYOCARDIAL INFARCTION IN REAL CLINICAL PRACTICE OF UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT

Background: High-sensitivity cardiac troponin (hs-cTn) is a key biomarker used in the assessment of patients presenting with chest pain. The European society of cardiology (ESC) recently changed recommendations in favour of using the ESC 0/1 h instead of the ESC 0/3 h algorithm if a hs-cTn assay with a validated algorithm is available.

Aim: To evaluate the diagnostic performance of both ESC rapid rule out/rule in algorithms in real clinical practice.

Methods and results: We prospectively enrolled 672 patients presenting with symptoms of acute coronary syndrome without ST elevation to the emergency room of the university hospital. Safety was compared using the negative predictive value (NPV) for the rule-out group, and accuracy using the positive predictive value (PPV) for the rule-in group. The final diagnosis was decided by 2 independent cardiologists using all available information, including cardiac catheterization and non-invasive imaging. Patients were contacted 3 months after discharge by telephone calls. Among 672 patients AMI was the final diagnosis in 152 (21 %). NPV for rule-out was higher in 0/1h algorithm (99,5 %) than in 0/3h algorithm (98,9 %). PPV was comparable between both algorithms (60,4 % versus 60,3 %). No death occurred in the rule-out group during three months of follow-up.

Conclusion: Both 0/1h and 0/3h algorithms were comparable in diagnostic accuracy for rule-in. The 0/1h algorithm in our study was revealed to be safer than the 0/3h algorithm.