Methodology: 3/5          
Usefulness: 3/5

Twerenbold R, et al. J Am Coll Cardiol. 2019 Jul 30;74(4):483-494.

Editorial: Evaluating Suspected Acute MI in the Emergency Department: What Is and What Should Never Be.

Question and Methods: Prospective international study of the impact on management and patient safety using the ESC 0/1hr high-sensitivity troponin algorithm in the ED for patients with suspected NSTEMI.

Findings: 94% adherence to the 0/1hr protocol; 62% patients were able to be ruled out and 71% managed as outpatient using this algorithm. The 30-day MACE event was 0.2% and 0.1% in the rule-out group and outpatients, respectively.

Limitations: Large selection bias (all patients included presented with acute chest pain), only 36% women, excludes patients with end-stage renal disease requiring dialysis.

Interpretation: For patients presenting with chest pain < 12 hours, the 0/1hr ESC algorithm can safely rule in/out NSTEMI with very low rates of 30-day MACE in patients ruled-out or managed as outpatients, while also decreasing overall ED length of stay.

By: Dr. Tiffany Lam