Methodology: 3/5
Usefulness: 2/5

Ashburn NP, et al. JAMA Cardiol. 2023 Apr 1;8(4):347-356. 

Editorial: Critical Appraisal of the Negative Predictive Performance of the European Society of Cardiology 0/1-Hour Algorithm for Evaluating Patients With Chest Pain in the US.

Question and Methods: The authors completed preplanned subgroup analyses to determine if a 0-1 hour ultra-sensitive troponin algorithm could have a NNP of 99% for prediction of death or MI at 30 days among patients with and without known coronary disease.
Findings: The NNP for 30-day cardiac death or MI was 96.6%(95%CI, 92.8-98.8) among patients with known CAD and 98.9%(95%CI, 97.8-99.6) in patients without (P = .04).
Limitations: U.S. study with different practice pattern and different high sensitivity TnT threshold, higher than expected mortality and MI, and results were different than other studies of larger sample sizes.

Interpretation: The study failed to reach its intended target to have a NPP of 99% for death or MI among patient with or without known CAD using a strategy involving the measurement of high-sensitive TnT at 0-1 hour. We should not be adopting this strategy based on these findings.

By: Dr. Lucy Karp

JC Supervisor: Dr. Christian Vaillancourt




  • Lucy Karp

    Dr. Lucy Karp is a junior editor for the EMOttawa Blog, and is a FRCPC resident in the Department of Emergency Medicine, at the University of Ottawa.

    View all posts
  • Hans Rosenberg

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

    View all posts
  • Christian Vaillancourt

    Senior Scientist, Clinical Epidemiology Program Ottawa Hospital Research Institute Full Professor, Emergency Medicine University of Ottawa Research Chair in Emergency Cardiac Resuscitation, Emergency Medicine University of Ottawa Associate Medical Director, Regional Paramedic Program for Eastern Ontario Research Interests: Dr. Vaillancourt's current research program focuses on pre-hospital care, specifically improving care and survival for cardiac arrest and trauma victims.

    View all posts