An Updated Meta-Analysis on the European Society of Cardiology 0/1-Hour Algorithm's Efficacy and Safety Outcomes

Abstract

Background: In 2011, the European Society of Cardiology (ESC) has recommended the 0/1-hour algorithm with high-sensitivity cardiac troponin assays to diagnose acute myocardial infarction. However, there is no defined difference between high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI). Methods: We conducted the first meta-analysis of randomized controlled trials and observation studies from inception to 13 August 2021 that evaluated the 0/1-hour algorithm with hs-cTnT or hs-cTnI. The statistical analysis was performed using R version 3.6.3 with packages “metaprop” and “metafor”. We constructed two-by-two tables, pooled studies by a random-effects model using proportion, and calculated sensitivity, NPV, specificity, and PPV with 95% confidence intervals (CI). Results: Two RCTs and 15 observational studies were included with total of 17,883 patients and a median weighted follow-up period of 267 days. For hs-cTnT-Roche, the rates of pooled sensitivity was 98% (95% CI 94-99, I2 =87%), NPV was 99% (95% CI 98-100%, I2 =88%), specificity was 93% (95% CI 90-96%, I2 =98%), and PPV was 61% (95% CI 44-75%, I2 =98%). On the other hand, hs-cTnI-Pooled had a sensitivity of 99% (95% CI 97-99%, I2 =48%), NPV of 100% (95% CI 100-100%, I2 =41%), specificity of 95% (95% CI 94-97%, I2 =95%), PPV of 68% (95% CI 63-73%, I2 =71%) Conclusion: Assays of hs-cTnI-Pooled have higher values of sensitivity, NPV, specificity, and PPV when compared to hs-cTnT-Roche.