31 August 2026

Faster diagnosis of heart attacks: safe, but no influence on waiting time in the emergency room

Chest pain is one of the most common reasons for visiting the emergency room. To quickly rule out or confirm a heart attack, a two-step measurement of a highly sensitive blood biomarker called cardiac troponin is currently used. An international study led by the University Hospital of Basel now shows that the interval between measurements can be shortened without compromising diagnostic accuracy. However, this does not result in shorter stays in the emergency room.

The study, initiated and coordinated by DKF research group leaders Prof. Christian Müller and Prof. Jasper Boeddinghaus, involved 19 hospitals from ten countries on four continents. In total, more than 67'000 emergency department visits by 62'577 patients with acute chest pain were evaluated between 2020 and 2024.

Two diagnostic strategies were compared: Under the previous 0/3 hour pathway, the second troponin measurement is taken three hours after the first. The newer 0/1 hour pathway is recommended by European guidelines and calls for a second troponin measurement after just one hour. This is intended to allow for a faster determination of whether a myocardial infarction is present or can be ruled out.

The primary aim of the study was to investigate whether the faster diagnostic method is just as safe as the current approach and also leads to a shorter length of stay in the emergency department.

Safety confirmed

To evaluate safety, the researchers examined the incidence of deaths or heart attacks within 30 days of the emergency department visit.

The analysis showed that the two strategies did not differ with regard to this safety endpoint. Within 30 days, approximately 1.2 percent of patients in the 0/3-hour group and 1.1 percent in the 0/1-hour group suffered a myocardial infarction or died. Thus, the 0/1-hour pathway met the predefined safety criterion.

No reduction in length of stay

Another result, however, was surprising: Although the second blood sample was drawn significantly earlier, the length of stay for patients in the emergency department did not decrease. In both groups, the median length of stay was approximately five hours. Other factors, such as the time to hospital discharge or the rate of outpatient treatments, also did not change significantly.

The researchers suspect that organisational factors play a greater role than the faster availability of lab results. These include, for example, staffing shortages, bed capacity or the need for additional tests.

Challenges in implementation

The study shows that the introduction of new diagnostic procedures alone does not automatically lead to more efficient workflows. In many participating emergency departments, performing the second blood draw within just one hour proved to be an organisational challenge. Only about one-third of the blood draws intended for this purpose actually took place within the recommended time frame.

According to the researchers, therefore, in addition to diagnostic innovations, clinical processes must also be further optimised so that the potential of faster testing methods can be fully realised.

Key findings for clinical practice

The PRESC1SE-MI study is worldwide the largest randomised trial on diagnosis of myocardial infarction in the emergency department. The results support the current guideline recommendation for the use of the 0/1 hour pathway and show that it can be safely implemented in various healthcare systems.

At the same time, they highlight that additional organisational and structural improvements are necessary to achieve significant efficiency gains that will alleviate the burden on emergency departments.