0/1-hour versus standard care pathways in myocardial infarction — systematic review and individual patient data meta-analysis

0/1-hour IPDMA

Patient / Population Intervention / Exposure Comparison Outcome

In patients with suspected myocardial infarction in pooled pathway studies, the ESC 0/1-hour troponin algorithm did not improve diagnostic safety and efficacy compared with standard-care pathways.

N

110,933patients

Design

Systematic review and individual participant data meta-analysis of five randomised trials (46 sites in 14 countries, 110,933 emergency presentations) comparing the ESC 0/1-hour high-sensitivity troponin pathway with standard-care triage pathways (mainly 0/3-hour) in patients with suspected myocardial infarction; includes the PRESC1SE-MI stepped-wedge cluster-randomised trial.

Endpoint

—

Relevance

2Important — one of several pillars.

ResultAcross five randomised trials and 110,933 presentations, the 0/1-hour pathway showed no difference versus standard care in 30-day death or new type 1 myocardial infarction (pooled OR 0.83, 95% CI 0.45-1.53) and did not shorten emergency department length of stay (pooled ratio 1.03, 95% CI 0.85-1.25) or increase direct discharge from the emergency department.

Presented at ESC Congress 2026, Hot Line 4, 29 August, alongside PRESC1SE-MI; simultaneous publication in The Lancet, DOI pending.

Discussion & critique

The 0/1-hour algorithm was adopted to move patients out of the emergency department faster, and pooled across five randomised trials it does not. Diagnostic speed is not throughput: the time a faster rule-out saves is spent waiting for a bed, a review or a discharge letter, so the second troponin was never the bottleneck. The safety case for the algorithm is untouched — this analysis is about time, and the time was not saved.