Observational studyOpen heart2025
Resolving the observe zone: validation of the ESC 0/3-hour and the APACE criteria for NSTEMI triage.
Observational study in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03111862 (Observational Study on the Safety of Accelerated Rule-out Protocols in Patients Admitted With Chest Pain to a Crowded CPU), which is not on this map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Observational Study on the Safety of Accelerated Rule-out Protocols in Patients Admitted With Chest Pain to a Crowded CPU
Who cites it
2 citing papers in PubMed.
- Machine learning for diagnosing non-ST-segment elevation myocardial infarction: a derivation and validation study.EClinicalMedicine · 2026Article
- Development of a guideline-based clinical decision support system for emergency department assessment of suspected non-ST-elevation acute coronary syndromes.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundHigh-sensitivity cardiac troponin tests have enhanced early myocardial infarction diagnosis, yet many patients still land in the observe zone (OZ). Guidelines suggest a 3-hour troponin measurement for those in the European Society of Cardiology (ESC) 0/1 hour-algorithm's OZ, but evidence on extended troponin testing times and their impact on diagnostic accuracy and outcomes remains sparse.
methodsPatients with suspected acute coronary syndrome were consecutively enrolled in a single-centre observational study. The triage protocol allowed an optional third troponin measurement at 3 hours or later to evaluate the performance and safety of two validated triage algorithms used to resolve the OZ.
resultsOf the 4605 patients, 948 were triaged to the OZ (20.6%). The prevalence of non-ST-segment elevation myocardial infarction (NSTEMI) within the OZ was 7.2%. 212 patients (22.3% of OZ patients) had a third troponin measurement and were included in the comparative analysis. For diagnosing NSTEMI, the ESC 0/3-hour criteria showed lower sensitivity (69.4%) than the criteria defined in the Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) study (86.1%, p=0.053), with both having high negative predictive value (93.5% vs 87.5%, p=0.339). By definition, the ESC 0/3-hour algorithm categorises all patients into rule-in or rule-out, eliminating the need for an OZ, whereas 55.6% of patients remained in the OZ with the APACE criteria. Mortality rates in the OZ were similar across different timing protocols, with 30-day rates of 0.78% for third blood draws within 210 min (n=128) and 1.19% for those over 210 min (n=84); 3-year rates were 5.51% and 4.82%, confirming the safety of extended sampling.
conclusionsAlthough the ESC 0/3-hour criteria have a lower sensitivity than the APACE criteria, it is by definition more effective because it does not leave patients in the OZ. Extending the timing for the third troponin measurement beyond 3 hours proves to be effective and safe, supporting its implementation in clinical practice. TRIAL REGISTRATION NUMBER: NCT03111862.
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