Key Takeaways:
- The 0/1-hour hs-cTn algorithm is safe, non-inferior to usual care, and significantly increases ED discharge rates while reducing short-term cardiac events among Asian patients presenting with chest pain.
- Improved adherence to subsequent clinical management recommendations is crucial to fully optimize outcomes and ensure the effectiveness of rapid chest pain assessment strategies in Asian emergency care settings.
The DROP-Asian ACS study (UMIN000042461), presented at the American College of Cardiology’s Annual Scientific Session (ACC.25), demonstrated the safety and effectiveness of a rapid 0/1-hour high-sensitivity cardiac troponin (hs-cTn) algorithm for triaging patients presenting to emergency departments (ED) with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) in Asia.
This prospective, stepped-wedge, cluster-randomized trial included 3,869 patients presenting with chest pain to 12 hospitals across five Asian countries from July 2021 to June 2024. Patients received either usual care based on local guidelines or care utilizing the ESC-recommended 0/1-hour hs-cTn algorithm. The primary outcome was the 30-day incidence of major adverse cardiac events (MACE), defined as cardiovascular death, subsequent myocardial infarction (MI), or unplanned revascularization, tested for non-inferiority.
The results showed the 0/1-hour algorithm was non-inferior to usual care, with a lower 30-day MACE incidence (1.4% absolute reduction; upper limit of the one-sided 95% CI, -0.3%, meeting the prespecified 1.5% non-inferiority margin). Notably, the 0/1-hour approach significantly increased ED discharge rates from 41.0% to 59.1% (p<0.001). Among discharged patients, MACE rates were lower in the 0/1-hour group (1.4% vs. 2.0% in usual care). In the 0/1-hour algorithm’s “rule-out” cohort, only three patients out of 921 experienced a MACE within 30 days.
Despite overall positive results, adherence to subsequent management recommendations following algorithm triage was variable. Among patients identified as “rule-in,” adherence to recommended treatments was associated with substantially lower 30-day MACE (3% vs. 13.1% in those not adhering). The study emphasized significant regional healthcare variability, noting that most hospitals in the study had previously not adhered to the recommended 0/3-hour guidelines, highlighting a gap between guidelines and clinical practice in Asia.
Dr. Kenji Inoue, lead investigator from Juntendo University Nerima Hospital in Tokyo, concluded, “This study provides strong evidence supporting the 0/1-hour algorithm as a reliable and effective approach for risk stratification in chest pain patients. The algorithm facilitates early triage, optimizes resource utilization, and ensures patient safety, making it highly applicable in clinical practice. Its simplicity allows for seamless integration into diverse healthcare systems, including those in Asia, offering a valuable opportunity to enhance efficiency and streamline decision-making.”