ESC Rapid Rule-In, Rule-Out Algorithm for NSTEMI Safe, Accurate

BARCELONA, SPAIN — The European Society of Cardiology (ESC) 0/1-hour algorithm to “rule in” or “rule out” non-ST-segment-elevation MI (NSTEMI) in patients presenting to the emergency department with chest pain can quickly separate patients who need prompt treatment from those who can safely be discharged home, results of a large validation study suggest[1].

The findings “should give confidence in the high safety and applicability of this algorithm into daily clinical practice,” Dr Raphael Twerenbold (Cardiovascular Research Institute, Basel, Switzerland) said during a press conference here at the European Society of Cardiology 2017 Congress.

Specifically, in more than 4000 patients with a suspected MI, the ESC 0/1-hour algorithm appropriately identified patients who likely had, did not have, or might have NSTEMI, based on levels of high-sensitivity troponin T or I (hs-cTnT or I) in blood samples drawn when the patient arrived in the emergency room and an hour later.

Importantly, the safety, accuracy, and efficacy of this algorithm were similar in patients who presented 3 or more hours after their chest pain started or those who presented earlier, with less obvious signs of MI.

“Most important, safety comes first,” Twerenbold stressed to | Medscape Cardiology. That is, it is crucial to spot patients who really do have an NSTEMI, he said, so that they are not discharged home.

“Efficacy comes second,” he continued. That is, these high-sensitivity troponin levels at time 0 and 1 hour should be highly sensitive for triaging patients.

Applying the ESC 0/1 algorithm “is a game changer in the sense that the earlier you make the diagnosis, the sooner the patient is going to be directed to the right place” for treatment, which ups the odds of survival, ESC spokesperson Dr Sarah Catherine Clarke (Cambridge, United Kingdom), president of the British Cardiovascular Society, commented in an…

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