Performance of 0/1 h versus 0/3 h pathways in patients with suspected myocardial infarction: a systematic review and individual participant data meta-analysis of randomised controlled trials.

In 110 933 patient presentations with suspected myocardial infarction, the 0/1 h pathway showed 0·8% vs 1·0% 30-day all-cause death or new type 1 myocardial infarction (pooled OR 0·83, 95% CI 0·45–1·53).

• Why it matters: Guidelines recommend the 0/1 h pathway, but trials used different safety endpoints and often did not assess key efficacy outcomes consistently, leaving uncertainty about overall performance.
• What they did: The authors pooled individual participant data from five randomized trials comparing 0/1 h versus 0/3 h pathways, harmonising outcome definitions and using a two-stage random-effects meta-analysis.
• The result: Emergency department length of stay was 314 min vs 308 min (geometric mean ratio 1·03, 95% CI 0·85–1·25), and direct discharge occurred in 67·0% vs 65·8% (OR 1·31, 95% CI 0·79–2·16), with substantial between-trial heterogeneity.

AI summary of the abstract · may contain errors · not medical advice · read the paper.