Meta-analysis finds no clear ED efficiency gain with 0/1h MI pathway

A systematic review and individual participant data meta-analysis of five randomised trials (110,933 presentations) compared 0/1 h versus 0/3 h troponin testing pathways for suspected myocardial infarction. The analysis found low event rates with both pathways but an imprecise pooled safety estimate for 30-day death or new type 1 myocardial infarction (OR 0.83, 95% CI 0.45-1.53), and no clear reduction in emergency department length of stay or increase in direct discharge with the 0/1 h pathway, with substantial heterogeneity across trials. The authors state that treatment effects might not translate uniformly across health-care systems and that implementation decisions should account for broader diagnostic and organisational factors.

Most relevant for: Emergency department clinicians evaluating patients with suspected myocardial infarction using rapid troponin testing protocols.

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