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Review
. 2022 Apr 20;4(6):241-247.
doi: 10.1253/circrep.CR-22-0001. eCollection 2022 Jun 10.

Performance of the 0-Hour/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Chest Pain in the Emergency Department - A Systematic Review and Meta-Analysis

Osamu Nomura  1 , Katsutaka Hashiba  2 , Migaku Kikuchi  3 , Sunao Kojima  4 , Hiroyuki Hanada  1 , Toshiaki Mano  5 , Takeshi Yamamoto  6 , Takahiro Nakashima  7 , Akihito Tanaka  8 , Naoki Nakayama  9 , Junichi Yamaguchi  10 , Kunihiro Matsuo  11 , Tetsuya Matoba  12 , Yoshio Tahara  13 , Hiroshi Nonogi  14 ; Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
Affiliations
Review

Performance of the 0-Hour/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Chest Pain in the Emergency Department - A Systematic Review and Meta-Analysis

Osamu Nomura et al. Circ Rep. .

Abstract

Background: This study assessed the diagnostic performance of the 0-hour/1-hour (0/1-h) algorithm to rule in and rule out acute myocardial infarction (MI) in patients presenting to the emergency department (ED) for suspected acute coronary syndrome without ST-segment elevation, as recommended in the 2015 European Society of Cardiology (ESC) guideline. Methods and Results: Following the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) guidelines, a systematic review was conducted using the PubMed database from inception to March 31, 2020. We included any article published in English investigating the diagnostic performance of the ESC 0/1-h algorithm for diagnosing MI in patients with chest pain visiting the ED. Of 651 studies identified as potentially available for the study, 7 studies including 16 databases were analyzed. A meta-analysis of the diagnostic accuracy of the 0/1-h algorithm using high-sensitivity cardiac troponin I (hs-cTn) with 6 observational databases showed a pooled sensitivity of 99.3% (95% confidence interval [CI] 98.5-99.7%) and a pooled specificity of 90.1% (95% CI 80.7-95.2%). A meta-analysis of the diagnostic accuracy of 10 observational databases of the ESC 0/1-h algorithm using hs-cTn revealed a pooled sensitivity of 99.3% (95% CI 96.9-99.9%) and a pooled specificity of 91.7% (95% CI 83.5-96.1%). Conclusions: Our results demonstrate that the ESC 0/1-h algorithm can effectively rule in and rule out patients with non-ST-segment elevation MI.

Keywords: 0/1-h algorithm; High-sensitivity troponin; Pooled sensitivity; Pooled specificity; Suspected NSTEMI.

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Conflict of interest statement

T. Matoba is a member of Circulation Reports’ Editorial Team. The other authors declare no conflicts of interest with regard to this article.

Figures

Figure 1.
Figure 1.
Flowchart of the study selection process.
Figure 2.
Figure 2.
Summary of risk of bias and applicability concerns.
Figure 3.
Figure 3.
Summary of forest plots.
See this image and copyright information in PMC

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