Direct Comparison of the 0/1h‐ and 0/2h‐Algorithms in Patients With Prior Coronary Artery Bypass Grafting

BACKGROUND: The European Society of Cardiology (ESC) 0/1h-high-sensitivity cardiac troponin (hs-cTn)T/I-algorithms have lower efficacy in patients with prior coronary artery bypass grafting. We hypothesized that in these high-risk patients, the longer time to the second blood draw within the ESC 0/2h-hs-cTn-algorithms would increase efficacy, defined as the proportion of patients triaged to rule-in/out of myocardial infarction, versus the ESC-0/1h-hs-cTn-algorithms. METHODS: In a prospective international multicenter diagnostic study including patients presenting to the emergency department with acute chest discomfort, final diagnoses were centrally adjudicated according to the Universal Definition of Myocardial Infarction. Safety and efficacy of the guideline-recommended ESC 0/1h- and 0/2h-hs-cTn-algorithms using assay-specific use-optimized cut-offs were directly compared in patients with prior coronary artery bypass grafting. Findings were externally validated in an independent prospective US multicenter study. RESULTS: Among 356 patients (median [interquartile range] age 73 [64-80] years, prevalence of non-ST-segment-elevation myocardial infarction [NSTEMI]: 31% [n=112]), sensitivity for rule-out of NSTEMI was high for the ESC 0/1h- and 0/2h-hs-cTnT-Elecsys-algorithms (0/1h: 100% [95% CI 96.7-100]; 0/2h: Sensitivity: 99.1% [95% CI 95.1-99.8]). Specificity for rule-in of NSTEMI was also high (0/1h: 97.1% [95% CI 94.2-98.6]; 0/2h 98.4% [95% CI 95.9-99.4]). Efficacy was 50.6% for 0/1h and 58.4% for 0/2h (difference: 7.9% [95% CI 4.2-11.5]). Findings with higher efficacy for 0/2h versus 0/1h were confirmed using hs-cTnI-Architect (difference in efficacy 3.1% [95% CI 0.1-6.1]) and using hs-cTnI-Atellica in the external validation cohort (n=178; difference in efficacy 9% [95% CI 4.5-13.5]). CONCLUSIONS: The ESC 0/2h-hs-cTn-algorithms have higher efficacy and comparable safety versus the ESC 0/1h-hs-cTn-algorithms in patients with prior coronary artery bypass grafting. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00470587.

Authors

Institutions

Publication Details

Journal
Journal of the American Heart Association
Published
2026-08-20
DOI
https://doi.org/10.1161/jaha.125.046718
Primary Topic
Acute Myocardial Infarction Research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Direct Comparison of the 0/1h‐ and 0/2h‐Algorithms in Patients With Prior Coronary Artery Bypass Grafting

Omer Dzemali, Stephan Steuer, Ivo Strebel, Piotr Muzyk et al.
Journal of the American Heart Association
Acute Myocardial Infarction Research
article

Direct Comparison of the 0/1h‐ and 0/2h‐Algorithms in Patients With Prior Coronary Artery Bypass Grafting

Omer Dzemali, Stephan Steuer, Ivo Strebel, Piotr Muzyk, Pedro López‐Ayala, Michael Christ, Ksenija Slankamenac, Felix Mahfoud, Kathrin Meissner, Héctor Rodríguez Cetina Biefer, Luca Crisanti, Thomas Nestelberger, Jude Formambuh, Luca Koechlin, Nicolas Geigy, Eliška Potluková, James McCord, Jasper Boeddinghaus, Karin S. Wildi, Francisco Javier Martín‐Sánchez, Danielle Menosi Gualandro, Jonas Glaeser, Bent Heimbach, Christian Müller, Julia Reinhardt, Eliza Kaplan, Òscar Miró, Gordon Jacobsen, Lourdes Herraiz Recuenco, Gabrielle Huré, Katharina Rentsch, Desiree Wussler, Jeanne du Fay de Lavallaz, Esther Rodriguez Adrada, Jiri Parenica, Arnold von Eckardstein, Angelika Hammerer‐Lercher, Gemma Martinez‐Nadal, Tobias Zimmermann, Carlos Spagnuolo, MD Andreas Buser, Damian Kawecki, Dagmar I. Keller, Maria Rubini Gimenez, Beatriz López, Beata Morawiec, Paolo Bima, Christian Puelacher
article en

Abstract

BACKGROUND: The European Society of Cardiology (ESC) 0/1h-high-sensitivity cardiac troponin (hs-cTn)T/I-algorithms have lower efficacy in patients with prior coronary artery bypass grafting. We hypothesized that in these high-risk patients, the longer time to the second blood draw within the ESC 0/2h-hs-cTn-algorithms would increase efficacy, defined as the proportion of patients triaged to rule-in/out of myocardial infarction, versus the ESC-0/1h-hs-cTn-algorithms. METHODS: In a prospective international multicenter diagnostic study including patients presenting to the emergency department with acute chest discomfort, final diagnoses were centrally adjudicated according to the Universal Definition of Myocardial Infarction. Safety and efficacy of the guideline-recommended ESC 0/1h- and 0/2h-hs-cTn-algorithms using assay-specific use-optimized cut-offs were directly compared in patients with prior coronary artery bypass grafting. Findings were externally validated in an independent prospective US multicenter study. RESULTS: Among 356 patients (median [interquartile range] age 73 [64-80] years, prevalence of non-ST-segment-elevation myocardial infarction [NSTEMI]: 31% [n=112]), sensitivity for rule-out of NSTEMI was high for the ESC 0/1h- and 0/2h-hs-cTnT-Elecsys-algorithms (0/1h: 100% [95% CI 96.7-100]; 0/2h: Sensitivity: 99.1% [95% CI 95.1-99.8]). Specificity for rule-in of NSTEMI was also high (0/1h: 97.1% [95% CI 94.2-98.6]; 0/2h 98.4% [95% CI 95.9-99.4]). Efficacy was 50.6% for 0/1h and 58.4% for 0/2h (difference: 7.9% [95% CI 4.2-11.5]). Findings with higher efficacy for 0/2h versus 0/1h were confirmed using hs-cTnI-Architect (difference in efficacy 3.1% [95% CI 0.1-6.1]) and using hs-cTnI-Atellica in the external validation cohort (n=178; difference in efficacy 9% [95% CI 4.5-13.5]). CONCLUSIONS: The ESC 0/2h-hs-cTn-algorithms have higher efficacy and comparable safety versus the ESC 0/1h-hs-cTn-algorithms in patients with prior coronary artery bypass grafting. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00470587.

Journal of the American Heart Association
Henry Ford Health System (US), Hospital Clínico San Carlos (ES), Hospital Base (CL), University Hospital of Zurich (CH), Luzerner Kantonsspital (CH), Kantonsspital Aarau (CH), Universitat de Barcelona (ES)
Partnerships for the goals
Openalex Percentile: Top 9%
Acute Myocardial Infarction Research
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.