{
  "abstract": "Background Rapid triage of patients presenting with chest pain is essential for early diagnosis and safe disposition. The European Society of Cardiology (ESC) 0/1-hour hs-cTn algorithm has shown promising performance in Western cohorts, but evidence supporting its implementation in diverse Asian emergency department (ED) settings remains limited. Therefore, we evaluated the safety and clinical utility of the ESC 0/1-hour algorithm for chest pain triage across multiple Asian EDs.Methods This was a prospective, stepped-wedge, cluster-randomised trial conducted across 12 hospitals in five Asian countries, enrolling 3869 patients with suspected acute coronary syndrome without ST elevation (NSTE-ACS). Usual care involved troponin testing without standardised timing, whereas the 0/1-hour protocol followed ESC recommendations using high-sensitivity cardiac troponin T testing at baseline and 1 hour. The primary endpoint was 30-day major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction (MI) and unplanned revascularisation. Non-inferiority was assessed using a one-sided 95% CI with a margin of 1.5%.Results Of 3869 patients (2059 usual care; 1810 0/1-hour care), MACE occurred in 1.7% of usual care patients and 1.4% in the 0/1-hour care (upper one-sided 95% CI –0.3%), confirming non-inferiority. ED discharge rates were significantly higher with the 0/1-hour algorithm (60% vs 35%, p<0.001). Among 941 patients classified as low risk group, MACE occurred in only 3 patients, including one cardiovascular death and two unplanned revascularisations; no non-fatal MIs were reported.Conclusion The ESC 0/1-hour algorithm is safe and effective for rapid triage of chest pain in Asian EDs. These findings provide external validation of the 0/1-hour algorithm and support broader global implementation.Trial registration number UMIN000042461.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan",
        "Tokyo Heart Rhythm Clinic Shinjuku, Tokyo, Japan"
      ],
      "name": "Kenji Inoue"
    },
    {
      "affiliations": [
        "University Heart Center Hamburg, Hamburg, Germany"
      ],
      "name": "Raphael Twerenbold"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia"
      ],
      "name": "Sazzli Kasim"
    },
    {
      "affiliations": [
        "Institut Jantung Negara, Kuala Lumpur, Malaysia"
      ],
      "name": "Farina Mohd Salleh"
    },
    {
      "affiliations": [
        "Institut Jantung Negara, Kuala Lumpur, Malaysia"
      ],
      "name": "Ahmad Suhailan Mohamed"
    },
    {
      "affiliations": [
        "National University Heart Centre Singapore, National University Health System, Singapore"
      ],
      "name": "Jack Wei Chieh Tan"
    },
    {
      "affiliations": [
        "National University Heart Centre Singapore, National University Health System, Singapore"
      ],
      "name": "Xin Yi Lim"
    },
    {
      "affiliations": [
        "National University Heart Centre Singapore, National University Health System, Singapore"
      ],
      "name": "Ting Boon Ping"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia"
      ],
      "name": "Bakhtiar Ahmad"
    },
    {
      "affiliations": [
        "Kuala Lumpur Hospital, Kuala Lumpur, Malaysia"
      ],
      "name": "Alzamani Mohammad Idrose"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"
      ],
      "name": "Arintaya Phrommintikul"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"
      ],
      "name": "Pannipa Suwannasom"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"
      ],
      "name": "Chanon Changratanakorn"
    },
    {
      "affiliations": [
        "Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan"
      ],
      "name": "Kazuhiko Yumoto"
    },
    {
      "affiliations": [
        "Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan"
      ],
      "name": "Tomoyuki Fukuzawa"
    },
    {
      "affiliations": [
        "Cardiology, Teikyo University School of Medicine Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Ken Kozuma"
    },
    {
      "affiliations": [
        "Cardiology, Teikyo University School of Medicine Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Naoyuki Yokoyama"
    },
    {
      "affiliations": [
        "Cardiology, Sakakibara Heart Institute, Tokyo, Japan"
      ],
      "name": "Mamoru Nanasato"
    },
    {
      "affiliations": [
        "Cardiology, Sakakibara Heart Institute, Tokyo, Japan"
      ],
      "name": "Ryosuke Higuchi"
    },
    {
      "affiliations": [
        "Emergency and Intensive Care Unit, Juntendo University Urayasu Hospital, Chiba, Japan"
      ],
      "name": "Yohei Hirano"
    },
    {
      "affiliations": [
        "Shimada General Hospital, Chiba, Japan"
      ],
      "name": "Issei Shimada"
    },
    {
      "affiliations": [
        "Taipei City Hospital Yangming Branch, Taipei City, Taipei City, Taiwan"
      ],
      "name": "Shuo Ju Chiang"
    },
    {
      "affiliations": [
        "Japanese Organisation for Research and Treatment of Cancer, Tokyo, Japan"
      ],
      "name": "Shunsuke Oyamada"
    },
    {
      "affiliations": [
        "Universitaetsklinikum Heidelberg, Heidelberg, Germany"
      ],
      "name": "Evangelos Giannitsis"
    },
    {
      "affiliations": [
        "Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Tohru Minamino"
    },
    {
      "affiliations": [],
      "name": "DROP-Asian ACS Investigators"
    }
  ],
  "title": "Validation of the European Society of Cardiology 0/1-hour algorithm for chest pain triage in Asian emergency departments: a multinational stepped-wedge cluster-randomised trial",
  "uid": "b68cdaaa-fa1a-5369-8741-fd1125ad7f22"
}