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

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.