An international study led by National Taiwan University Hospital (NTUH) has found that one-hour tests for diagnosing a myocardial infarction are more accurate than more established algorithms that can take three hours or longer.
Lee Chien-chang (李建璋), a professor at NTUH’s Department of Emergency Medicine who led the study, shared its findings at a news conference in Taipei on Friday, after it was published in the Annals of Internal Medicine on Tuesday.
The 2020 European Society of Cardiology guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm, as the first and second choices for high-sensitivity cardiac troponin-based strategies for triage of patients with suspected acute myocardial infarction, the study said.
After analyzing 32 studies from 11 countries involving 30,066 patients, the study evaluated the diagnostic accuracy of the three algorithms.
With the 0/3-hour algorithm, which is more widely used in hospitals, people suspected to have had a myocardial infarction have to receive two cardiac troponin tests, one at the beginning and one after three hours, Lee said.
That means they have to wait longer in the emergency room, which not only makes the room more crowded, but exposes them to a higher risk of contracting diseases such as COVID-19, Lee said.
The team’s study found that, compared with the 0/1-hour and 0/2-hour algorithms, the 0/3-hour algorithm has a lower precision rate for myocardial infarction, he said.
While there is a popular notion in the medical field that the different algorithms only vary in their efficiency, the study found they are also pertinent to the safety of patients, he added.
With the 0/3-hour algorithm, up to 15 out of 1,000 patients with acute myocardial infarction could be misidentified as healthy, while the number drops to three when using the newer 0/1 and 0/2-hour procedures, Lee said.
New testing methods were launched a few years ago, and their use is covered by the National Health Insurance, so it would not be difficult to promote their use in more hospitals, he said.
The study is expected to trigger changes in the guidelines followed by emergency rooms and prompt more surgeons to adopt the new procedures, the hospital said.
Additional reporting by CNA
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