Accuracy of the European Society of Cardiology 0/1-, 0/2-, and 0/3-hour algorithms for diagnosing acute myocardial infarction

摘要

NARRATIVE:Chest pain is a common presentation to the emergency department (ED), representing over 5 million annual ED visits in the United States.1 However, only 10%-20% of ED patients with chest pain are ultimately diagnosed with acute myocardial infarction (AMI).2 Evaluation using accelerated diagnostic protocols with high-sensitivity cardiac troponin (hs-cTn) tests can provide more rapid detection of AMI and earlier discharge for patients in whom AMI has been excluded when compared to standard troponin assays.3,4 Recent guidelines utilize hs-cTn in evaluation for AMI,5 while prior guidelines incorporated standard troponin assays at the initial time of presentation and at 3 h.6-8 The most recent European Society of Cardiology (ESC) guidelines use specific hs-cTn T or I thresholds at 0 h and 1 or 2 h and absolute changes to determine who may be ruled in or ruled out for AMI as well as those who require observation.5