Emre Kudu, Ahmet Enes Kucukardali, Mustafa Altun, Ümit Öztürk, Erhan Altunbaş, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi
{"title":"在拥挤的急诊科，ESC 0/1小时算法对非st段抬高型心肌梗死的诊断准确性：来自<s:1> rkiye单中心的真实世界经验","authors":"Emre Kudu, Ahmet Enes Kucukardali, Mustafa Altun, Ümit Öztürk, Erhan Altunbaş, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi","doi":"10.1186/s12873-025-01289-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye.</p><p><strong>Methods: </strong>This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days.</p><p><strong>Results: </strong>Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as \"rule-out,\" 31.3% as \"observe,\" and 12.3% as \"rule-in.\" The sensitivity and negative predictive value (NPV) for NSTEMI in the \"rule-out\" group were both 100%. In the \"rule-in\" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the \"rule-out\" group, 13.9% in the \"observe\" group, and 67.0% in the \"rule-in\" group.</p><p><strong>Conclusions: </strong>The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"129"},"PeriodicalIF":2.3000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269136/pdf/","citationCount":"0","resultStr":"{\"title\":\"The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye.\",\"authors\":\"Emre Kudu, Ahmet Enes Kucukardali, Mustafa Altun, Ümit Öztürk, Erhan Altunbaş, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi\",\"doi\":\"10.1186/s12873-025-01289-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye.</p><p><strong>Methods: </strong>This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days.</p><p><strong>Results: </strong>Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as \\\"rule-out,\\\" 31.3% as \\\"observe,\\\" and 12.3% as \\\"rule-in.\\\" The sensitivity and negative predictive value (NPV) for NSTEMI in the \\\"rule-out\\\" group were both 100%. In the \\\"rule-in\\\" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the \\\"rule-out\\\" group, 13.9% in the \\\"observe\\\" group, and 67.0% in the \\\"rule-in\\\" group.</p><p><strong>Conclusions: </strong>The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>\",\"PeriodicalId\":9002,\"journal\":{\"name\":\"BMC Emergency Medicine\",\"volume\":\"25 1\",\"pages\":\"129\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-07-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269136/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12873-025-01289-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12873-025-01289-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye.
Background: The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye.
Methods: This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days.
Results: Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as "rule-out," 31.3% as "observe," and 12.3% as "rule-in." The sensitivity and negative predictive value (NPV) for NSTEMI in the "rule-out" group were both 100%. In the "rule-in" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the "rule-out" group, 13.9% in the "observe" group, and 67.0% in the "rule-in" group.
Conclusions: The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes.
期刊介绍：
BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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