The usefulness of 0/1-hour algorithm using high-sensitivity cardiac troponin I for evaluating the patients with chest pain in the emergency department

Park, Ki Beom; Kim, Jong Won; Lee, Kyeong Ryong; Hong, Dae Young; Park, Sang O; Lee, Young Hwan; Kim, Sin Young

J Korean Soc Emerg Med > Volume 35(5); 2024 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2024;35(5): 345-352.

응급실에서 흉통 환자 평가에 고감도 심장 트로포닌을 이용한 0/1시간 알고리즘의 유용성

박기범

건국대학교병원 응급의학과

The usefulness of 0/1-hour algorithm using high-sensitivity cardiac troponin I for evaluating the patients with chest pain in the emergency department

Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Correspondence

Jong Won Kim ,Tel: 02-2030-5555, Fax: 02-2030-5780, Email: 20130296@kuh.ac.kr,

Received: September 9, 2023; Revised: October 24, 2023 Accepted: October 31, 2023. Published online: October 30, 2024.

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.
Method:
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.

Key words: Chest pain; Troponin I; Myocardial infarction