- Design
- Systematic review and individual participant data meta-analysis of 5 RCTs
- Population
- 110,933 emergency presentations with suspected myocardial infarction
- Primary outcome
- 30-day death or new type 1 MI; ED length of stay; direct discharge
- Effect
- 0.8% vs 1.0%, OR 0.83 (0.45–1.53); stay 314 vs 308 min, ratio 1.03 (0.85–1.25)
This Lancet systematic review obtained individual patient data from all five randomised trials comparing a 0/1 h high-sensitivity troponin pathway with a 0/3 h pathway in suspected myocardial infarction, and harmonised the outcomes. It covered 110,933 presentations.
Death or new type 1 MI within 30 days occurred in 0.8% with 0/1 h and 1.0% with 0/3 h (OR 0.83, 95% CI 0.45–1.53). Median emergency department stay was 314 against 308 minutes, and direct discharge 67.0% against 65.8%; neither difference was significant. Heterogeneity between trials was very high.
The 0/1 h pathway is already in guidelines, and this does not show it is unsafe. What it shows is that shortening the blood-draw interval does not by itself empty a department: the bottleneck is usually the laboratory turnaround, imaging and beds. The safety outcome was also refined after the data were received, which the authors declare.
- Keep using a validated high-sensitivity troponin pathway, whichever interval your hospital has adopted.
- Do not expect a switch to 0/1 h alone to shorten emergency stays.
- Look at laboratory turnaround and discharge processes if flow is the problem.
- Use the assay-specific cut-offs for the pathway you run, not borrowed thresholds.
Why it matters
It challenges the assumption that a faster blood-draw schedule translates into faster, equally safe care.
Don't overread it
The pooled safety estimate is too imprecise to show either pathway is safer.
The statistics, in plain English
An OR of 0.83 with an interval from 0.45 to 1.53 is compatible with a 55% reduction or a 53% increase in harm — the data cannot tell. I² above 97% for length of stay means the trials disagreed so much that a single average hides very different results in different hospitals.
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