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The PRESC1SE-MI study compares two algorithms for triage of patients presenting with chest pain and symptoms of heart attack (myocardial infarction) to the emergency department. Both algorithms are recommended by the European Society of Cardiology: the 0/3-hour algorithm and the 0/1-hour algorithm.
Currently, most emergency departments worldwide use the 0/3-hour troponin algorithm. Cardiac troponin (cTn) is a heart-specific biomarker which indicates damage of the heart muscle and which increases after a heart attack. In the 0/3-hour algorithm, the amount of troponin in the bloodstream is measured with a high-sensitivity assay at admission and 3 hours thereafter. Likewise, the 0/1-hour algorithm means that the blood sample in which the troponin is measured is collected at admission and 1 hour later. Since recent clinical studies suggest that the 0/1-hour algorithm is superior to the 0/3-hour algorithm, many hospitals consider switching to the 0/1-hour algorithm.
The aim of this study is to assess how feasible the time-saving 0/1-hour algorithm would be in reality and whether it provides the same accuracy and safety in the diagnosis of myocardial infarction as the current practice the 0/3-hour algorithm.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 0/1-hour algorithm | Experimental | High-sensitivity cardiac troponin (hs-cTn) blood tests are performed at admission (0 h) and 1 hour later in the emergency department. |
|
| 0/3-hour algorithm | Active Comparator | High-sensitivity cardiac troponin (hs-cTn) blood tests are performed at admission (0 h) and 3 hours later in the emergency department. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| European Society of Cardiology hs-cTnT/I 0 h/1 h algorithm | Diagnostic Test | High-sensitivity cardiac troponin (hs-cTn) blood tests are performed at admission (0 h) and 1 hour later in the emergency department. |
| Measure | Description | Time Frame |
|---|---|---|
| Composite of all-cause mortality or new AMI (type 1) occurring within 30 days of index presentation | Mortality rate and number of newly diagnosed AMI (type 1) in all enrolled patients | 30 days |
| Time from ED presentation to ED discharge or transfer | Length of stay in the ED measured in hours | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients managed as outpatients | Number of patients who stay in hospital for index event less than 24 hours | 24 hours |
| Readmission for suspected AMI within 30 days after index presentation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Christian Müller, MD Prof. | University Hospital, Basel, Switzerland | Principal Investigator |
| Jasper Boeddinghaus, MD | University Hospital, Basel, Switzerland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Baylor St. Luke's Medical Center | Houston | Texas | 77030 | United States | ||
| St Andrew's War Memorial Hospital Brisbane |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41177204 | Derived | Boeddinghaus J, Bima P, Crisanti L, Keller DI, Slankamenac K, Christ M, Schuetz P, Wiencierz A, Strebel I, Reinhardt J, Vyshnevska I, Tsao TY, Mahfoud F, Ruggieri MP, Steuer S, Miro O, Harjola VP, Morello F, Nazerian P, Roth D, Zamorano JL, Gannon DE, Pott J, Abubakr MO, Yang HS, Young J, Bicette R, Cuculici A, Bueno H, Sanchis J, Mueller C; PRESC1SE-MI investigators. PRospective evaluation of the European Society of Cardiology 0/1h-algorithm;s safety and efficacy for triage of patients with suspected myocardial infarction (PRESC1SE-MI): Rationale and design of a prospective international multicenter stepped-wedge cluster randomized controlled trial. Am Heart J. 2026 Feb;292:107299. doi: 10.1016/j.ahj.2025.107299. Epub 2025 Oct 31. |
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prospective stepped-wedge cluster randomised controlled trial, sites are randomly assigned to either early initiation or late initiation of the ESC hs-cTnT/I 0/1h-algorithm and compared to the standard of care ESC hs-cTnT/I 0/3h-algorith
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|
| European Society of Cardiology hs-cTnT/I 0 h/3 h algorithm | Diagnostic Test | High-sensitivity cardiac troponin (hs-cTn) blood tests are performed at admission (0 h) and 3 hours later in the emergency department. |
|
|
Number of patients who stay in hospital for a new suspected AMI more than 24 hours within 30 days of index presentation
| 30 days |
| All-cause mortality at 30 days in all patients | Number of deceased patients within 30 days after index presentation | 30 days |
| All-cause mortality at 365 days in all patients | Number of deceased patients within 365 days after index presentation | 365 days |
| New AMI (type1) at 30 days in all patients | Number of newly diagnosed AMI (type 1) in all patients within 30 days of index presentation | 30 days |
| New AMI (type 1) at 365 days in all patients | Number of newly diagnosed AMI (type 1) in all patients within 365 days of index presentation | 365 days |
| Composite of all-cause mortality or new AMI (type 1) at 365 days after index presentation | Mortality rate and number of newly diagnosed AMI (type 1) in all enrolled patients | 365 days |
| Satisfaction of patients with their evaluation in the ED | Satisfaction will be measured on a numerical/visual analogue scale from 0-100%, the higher the score, the greater the satisfaction | 30 days |
| Treatment costs in the ED | Costs of procedures performed in the ED will be calculated according to national remuneration systems | 365 days |
| Length of stay in the ED | Length of stay from admission to the ED to discharge or transfer will be calculated according to national remuneration systems | 30 days |
| Feasibility of the 0/1-hour algorithm | Feasibility defined as the percentage of patients in whom the "1h" blood draw is performed within 1h +/- 20 minutes from the "0h" blood draw | 80 minutes |
| Effectiveness of rule-in | Effectiveness defined as the time from presentation to coronary angiography in patients ultimately diagnosed with AMI (type 1) | 30 days |
| Effectiveness of rule-out | Effectiveness defined as time from presentation to discharge in patients ultimately diagnosed with non-cardiac disease | 30 days |
| Brisbane |
| Australia |
| Vienna General Hospital (AKH Wien) | Vienna | Austria |
| University Central Hospital Helsinki | Helsinki | Finland |
| Attikon General Hospital Athens | Athens | Greece |
| Careggi University Hospital Florence | Florence | Italy |
| Azienda Ospedaliera San Giovanni Addolorata | Roma | Italy |
| Hospital Città della Salute e della Scienza di Torino | Torino | Italy |
| Emergency Institute for Cardiovascular Diseases C.C. Iliescu | Bucharest | Romania |
| Konkuk University Medical Center | Seoul | South Korea |
| Hospital Clinic Barcelona | Barcelona | Spain |
| University Hospital October 12 Madrid | Madrid | Spain |
| University Hospital Ramon y Cajal | Madrid | Spain |
| Hospital Clínico Universitario Valencia | Valencia | Spain |
| Kantonsspital Aarau | Aarau | Switzerland |
| St. Claraspital | Basel | Switzerland |
| Kantonsspital Luzern | Lucerne | Switzerland |
| University Hospital Zurich | Zurich | Switzerland |
| Royal London Hospital | London | United Kingdom |
| Royal Cornwall Hospitals Treliske | Truro | United Kingdom |
| ID | Term |
|---|---|
| D000072658 | Non-ST Elevated Myocardial Infarction |
| D004630 | Emergencies |
| D002637 | Chest Pain |
| D009203 | Myocardial Infarction |
| D000789 | Angina, Unstable |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D020969 | Disease Attributes |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D000787 | Angina Pectoris |
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| ID | Term |
|---|---|
| D000465 | Algorithms |
| ID | Term |
|---|---|
| D055641 | Mathematical Concepts |
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