A large-scale trial finds that while the 0/1-hour diagnostic pathway is safe, it does not accelerate patient care as previously assumed.
A rapid diagnostic pathway for heart attacks in the emergency department (ED) is as safe as a slower pathway but does not reduce the length of time patients spend in the ED or increase direct discharge rates, according to findings from the PRESC1SE-MI trial presented at the European Society of Cardiology Congress 2026.
The study, which was published simultaneously in The Lancet, analyzed 67,624 consecutive patient presentations across 20 hospitals in 11 countries. Researchers compared the 0/1-hour pathway, which uses clinical assessment and two cardiac troponin measurements taken one hour apart, against the standard 0/3-hour pathway.
Safety and Efficacy Results
The occurrence of the co-primary safety outcome—death from any cause or new type 1 myocardial infarction (MI) within 30 days—was 1.1% with the 0/1-hour pathway compared to 1.2% with the 0/3-hour pathway. These results confirm the safety of the more rapid diagnostic approach.
However, the median ED length of stay was 309 minutes in both groups, indicating that earlier re-testing did not lead to faster patient throughput.
“These findings are important to healthcare providers worldwide as they contradict current assumptions that implementing 0/1-hour testing improves patient management in the ED,” says Jasper Boeddinghaus, MD, PhD, co-principal investigator of the PRESC1SE-MI trial and professor at University Hospital Basel and University Hospital Bonn, in a release. “It seems that other processes—including specialist review, admissions workflow and bed availability—may have a greater influence on ED length of stay than the testing strategy alone.”
Meta-Analysis Supports Findings
The congress also featured an independent participant data meta-analysis of all available randomized trials evaluating the 0/1-hour pathway. This analysis included 110,933 patient presentations across five trials.
The meta-analysis results mirrored the trial findings, showing that the 0/1-hour pathway provided similar safety to standard care but failed to reduce ED length of stay or increase direct discharge from the ED.
To better realize the potential of rapid testing, Boeddinghaus suggests that integrating the 0/1-hour pathway into electronic healthcare records as a clinical decision-support tool may help improve patient management and healthcare system efficiency.
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