Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.
Jonas, L., Betül, T., Arne, S.N., Linlin, G., Michael, H.P., Alina, S., Niklas, T., Lea, S., Ben, V., Tanja, Z., Tobias, N.J., & Raphael, T. (2026). Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.. Eur Heart J Qual Care Clin Outcomes. https://doi.org/10.1093/ehjqcco/qcag062
Jonas L, Betül T, Arne SN, Linlin G, Michael HP, Alina S, et al. Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.. Eur Heart J Qual Care Clin Outcomes. 2026; doi: 10.1093/ehjqcco/qcag062
Jonas L, Betül T, Arne SN, et al. Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.[J]. Eur Heart J Qual Care Clin Outcomes. 2026. DOI: 10.1093/ehjqcco/qcag062.
@article{jonas2026,
author = {Lehmacher Jonas and Toprak Betül and Sörensen Nils Arne and Guo Linlin and Haller Paul Michael and Schock Alina and Thießen Niklas and Scharlemann Lea and Völschow Ben and Zeller Tanja and Neumann Johannes Tobias and Twerenbold Raphael},
title = {Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T.},
journal = {Eur Heart J Qual Care Clin Outcomes},
year = {2026},
doi = {10.1093/ehjqcco/qcag062},
note = {PMID: 42013281},
}
TY - JOUR AU - Lehmacher Jonas AU - Toprak Betül AU - Sörensen Nils Arne AU - Guo Linlin AU - Haller Paul Michael AU - Schock Alina AU - Thießen Niklas AU - Scharlemann Lea AU - Völschow Ben AU - Zeller Tanja AU - Neumann Johannes Tobias AU - Twerenbold Raphael TI - Diagnostic validation and prognostic implications of serial 0/1/3h stratification in patients with suspected myocardial infarction using high-sensitivity troponin T. T2 - Eur Heart J Qual Care Clin Outcomes PY - 2026 DO - 10.1093/ehjqcco/qcag062 AN - PMID:42013281 ER -
The European Society of Cardiology (ESC) recommends 0/1h-algorithms for triage of patients with suspected myocardial infarction (MI). Recently, cut-offs allowing 3h triage using high-sensitivity cardiac troponin T (hs-cTnT) have been derived, but their prognostic implications remain unclear, and external validation is lacking. To externally validate the diagnostic performance and assess the prognostic impact of the 0/1/3h algorithm for cardiovascular events in an all-comer cohort with suspected MI. We prospectively enrolled patients presenting to the emergency department with suspected MI. hs-cTnT was measured at presentation, 1h, and 3h. Patients were followed up to evaluate all-cause mortality and major adverse cardiovascular events (MACE). Diagnostic accuracy was assessed by stratifying patients using the 0/1/3h algorithm. Cox regression analyses compared cardiovascular risk at 90 days and three years between rule-in and rule-out groups. Among 2,514 patients (median age 64 years; 63.6% men), the algorithm demonstrated excellent rule-out safety (sensitivity 98.6% [95% CI, 96.8, 99.4]; NPV 99.7% [99.2, 99.9]) and moderate rule-in capacity (specificity 89.3% [87.9, 90.5]; PPV 60.8% [56.8, 64.7]). Over three years, 646 patients experienced MACE, and 256 died (68 cardiac deaths). Patients ruled-out at 3h had doubled MACE risk (HR 2.11 [1.44, 3.08]) and quadrupled mortality risk (HR 4.33 [1.85, 10.12]) compared to immediate rule-out (p<0.001). The 0/1/3h algorithm shows excellent diagnostic safety and adds prognostic value, with delayed rule-out associated with significantly increased long-term cardiovascular risk and mortality.