A rapid and accurate diagnosis is critical when patients arrive with acute chest pain and suspected heart attack (acute myocardial infarction, AMI) in the emergency department of a hospital. Previous data show that every 30 minutes of delay from the onset of symptoms to treatment significantly increases the risk of death in patients with AMI.
An earlier study called the TRAPID-AMI study showed that the 0-hour/1-hour algorithm using the Roche cardiac Troponin T-high sensitive test provided a safe, effective and rapid diagnosis within a 1-hour observation time which is faster than the 3 – 6 hours observation time using the conventional diagnostic approach.
In 2017, the accelerated 0 –1hour algorithm was validated among Asian patients too, as part of a first-ever study conducted in Japan and Taiwan. The multi-center study, which included 413 patients across three hospitals in Japan and Taiwan, is the first to demonstrate the clinical significance of the 0-hour/1-hour algorithm in Asia and was shown to be just as effective in Asian settings.
Troponin is a heart muscle protein that is released into the blood stream during a heart attack. Elevated troponin levels indicate the occurrence of a heart attack. It is also the most preferred biomarker for the diagnosis of heart attack in clinical practice.
Dr Kenji Inoue, Associate Professor, Department of Cardiology, Juntendo University Nerima Hospital, Tokyo and principal investigator of the study, said, “For patients with suspected AMI, quick and accurate diagnosis can mean the difference between life and death. The study proves that the accelerated algorithm using the cardiac Troponin T–high sensitive test works in Asian settings. This can help to ensure patients with AMI get the right treatment faster, while those with chest pain caused due to other reasons can be directed to the appropriate departments, as necessary.”
This accelerated diagnosis is now supported by the new 2015 guidelines of the European Society of Cardiology (ESC).
Growing public health challenge
With the rising burden of chronic diseases and fast-ageing populations in Asia, crowding in the emergency room (ER) is becoming a major public health concern. While this is not a problem unique to Asia, it has grave implications on patient outcomes as well as already overburdened hospital resources.
“In Taiwan, patients with chest pain and other heart attack symptoms account for six to eight percent of all emergency department consultations. The implementation of the one-hour algorithm can not only ensure timely intervention for heart attack patients, but also give doctors the confidence to send patients, who aren’t at-risk, home. At the same time, the faster decision-making may help overburdened hospitals to better manage the emergency room workload. Ultimately, this can reduce the related costs for healthcare systems,” said Dr. Lee Chien Chang, Associate Professor of Emergency Medicine, National Taiwan University Hospital, Taiwan and co-investigator of this study.
Since the publication of the study, several countries in Asia are now reviewing the adoption of the one-hour algorithm in clinical practice to enable the faster diagnosis of heart attacks.
Infographics Credit: Roche