The usefulness of 0/1-hour algorithm using high-sensitivity cardiac troponin I for evaluating the patients with chest pain in the emergency department
- Author:
Ki Beom PARK
1
;
Jong Won KIM
;
Kyeong Ryong LEE
;
Dae Young HONG
;
Sang O PARK
;
Young Hwan LEE
;
Sin Young KIM
Author Information
1. Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Journal of the Korean Society of Emergency Medicine
2024;35(5):345-352
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Objective:This study examined whether the European Society of Cardiology (ESC) 0/1-hour algorithm using a high-sensitivity troponin I (hs-cTnI) assay can effectively classify patients presenting with chest pain at the emergency department.
Methods:This study conducted a retrospective chart review of patients presenting with chest pain suspicious of myocardial ischemia. hs-cTnI was measured at presentation and after one hour. The patients were classified into three groups using hs-cTnI: rule out, observation, and rule in according to the ESC 0/1-hour algorithm to evaluate the diagnostic performance of acute myocardial infarction (AMI). This study evaluated the negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and the proportion of patients assigned to the observation.
Results:Among 384 patients, 77 were diagnosed with AMI. Following classification using the ESC 0/1-hour algorithm, there were 206 (53.6%), 77 (20.1%), and 101 (26.3%) patients were classified as “rule-out,” “rule-in,” and “observation,” respectively. In “rule-out,” the NPV and sensitivity for AMI were 99.0% (95% confidence interval [CI], 96.5-99.9) and 97.4% (95% CI, 90.9-99.7), respectively. In “rule-in,” the PPV and specificity for AMI were 83.1% (95% CI, 72.9-90.7) and 95.8% (95% CI, 92.9-97.7).
Conclusion:The ESC 0/1-hour algorithm allows for quick and accurate categorization of patients presenting with ischemic chest pain into the “rule-out” or “rule-in” group for the diagnosis of AMI. Therefore, applying this accelerated algorithm for evaluating chest pain in the emergency department in Korean patients would be helpful.
