A multicenter prospective study on the ESC algorithm for the early diagnosis of non-ST-elevation myocardial infarction

Yahui Lin; Hong Zhan; Shukui Wang; Guozheng Zhang; Zi Ye; Caidong Liu; Dong Wang; Dongfang Gao; Qing Yang; Zebin Gong; Guangxun Feng; Min Liu; Wenke Li; Yanmin Yang; Jun Zhu; Zhou Zhou; Yan Liang

doi:10.1016/j.isci.2024.110643

A multicenter prospective study on the ESC algorithm for the early diagnosis of non-ST-elevation myocardial infarction

iScience. 2024 Aug 5;27(9):110643. doi: 10.1016/j.isci.2024.110643. eCollection 2024 Sep 20.

Authors

Yahui Lin¹, Hong Zhan², Shukui Wang³, Guozheng Zhang⁴, Zi Ye², Caidong Liu³, Dong Wang⁵, Dongfang Gao⁴, Qing Yang⁴, Zebin Gong⁴, Guangxun Feng⁴, Min Liu⁵, Wenke Li⁴, Yanmin Yang⁴, Jun Zhu⁴, Zhou Zhou¹, Yan Liang⁴

Affiliations

¹ Center of Laboratory Medicine, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
² Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
⁴ Emergency Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
⁵ Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Abstract

This study aimed to determine the optimal high-sensitivity cardiac troponin I (hs-cTnI)-based algorithm for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) in Chinese patients. We prospectively enrolled 1,606 patients with suspected NSTEMI from three emergency departments across China, collecting blood samples at 0, 1, and 3 h post-admission. Patients were classified using the 0/1-h and 0/3-h algorithms. The 2015 and 2020 ESC 0/1-h algorithms rapidly triaged 70% of patients with high negative predictive value (NPV) (99.7%) and sensitivity (99.5%). The 0/3-h algorithm showed higher specificity (93.8%) but lower NPV (96.8%) and sensitivity (91.2%). An optimized 0/1-h algorithm improved specificity to 92.1% while maintaining high NPV (99.7%) and sensitivity (99.2%). Low 30-day and 180-day all-cause mortality and major adverse cardiac event (MACE) rates were observed in rule-out groups for all algorithms. The ESC 0/1-h algorithm is a safe and efficient triage method for patients with suspected NSTEMI, with optimization further enhancing specificity and efficiency for the Chinese population.

Keywords: Bioinformatics; Cardiovascular medicine.