Safety and efficacy of the 0/1 h pathway for myocardial infarction in the emergency department: an international, pragmatic, stepped-wedge, cluster-randomised, controlled trial.

In 19-hospital, 10-country emergency departments, the 0/1 h high-sensitivity troponin pathway is non-inferior for 30-day death or new type 1 myocardial infarction versus 0/3 h.

• Why it matters: Hospitals not yet using the guideline 0/1 h strategy needed evidence that switching would be safe and whether it would improve emergency department throughput.
• What they did: PRESC1SE-MI was a pragmatic stepped-wedge cluster-randomised trial in consecutive adults with acute non-traumatic chest discomfort; hospitals adopted 0/1 h after 6 or 12 months versus 0/3 h, with a non-inferiority margin odds ratio 1·3.
• The result: Among 67,624 eligible presentations, 30-day death or new type 1 myocardial infarction occurred in 1·2% (0/3 h) vs 1·1% (0/1 h; adjusted odds ratio 0·93, 95% CI 0·77–1·13; p non-inferiority=0·0004), while emergency department length of stay was unchanged (median 309 min; ratio 1·00, 95% CI 0·97–1·02; p=0·65).

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