(Vienna, 3 November 2026) One of the main tasks of emergency medicine is to distinguish as quickly and reliably as possible between life-threatening conditions, such as a heart attack, and less dangerous causes in cases of acute chest pain. This usually requires several blood samples to be taken. In a large, randomised-controlled trial involving more than 67,000 patients from 19 hospitals in ten countries, an international research team – including the Department of Emergency Medicine at MedUni Vienna – has now demonstrated that a diagnostic pathway in which the blood sample is retaken after just one hour is just as reliable as one in which the follow-up test takes place only after three hours. The findings were confirmed in a subsequent meta-analysis of individual patient records from more than 110,000 people. The study also examined factors which, in addition to the diagnostic algorithm itself, influence the time taken until discharge from the A&E department. Both studies were published in the international medical journal The Lancet.
The challenge of chest pain: often harmless, but sometimes life-threatening
Acute chest pain is one of the most common reasons for visiting an A&E department. Whilst less serious causes, such as musculoskeletal problems, are identified in the majority of patients, in around five per cent of cases the underlying diagnosis is acutely life-threatening – most commonly a heart attack. Being able to distinguish between these groups as quickly and reliably as possible, in order to either initiate treatment promptly or facilitate discharge from hospital, presents a significant challenge. In addition to clinical expertise and a trusting dialogue between doctor and patient, the analysis of biomarkers – particularly high-sensitivity troponins – plays a crucial role here. It is usually necessary to carry out these tests several times in order to draw conclusions about possible damage to the heart muscle based on the progression of the markers.
International study and meta-analysis confirm safety
The PRESC1SE-MI study, one of the largest randomised trials in cardiovascular medicine, investigated under real-world conditions how safe a 0/1-hour protocol is compared with the previously established 0/3-hour protocol. In this approach, the concentration of certain cardiac markers in the blood is measured again either after one hour or after three hours. For the combined endpoint of death or recurrent heart attack within 30 days, the 0/1-hour algorithm was shown to have a safety profile at least equivalent to that of the 0/3-hour algorithm.
However, the significantly faster diagnostic process did not automatically lead to faster discharges from the A&E department. In a meta-analysis of individual data from more than 110,000 patients across 46 hospitals, the findings regarding the safety of the shortened diagnostic procedure were confirmed. It also emerged that organisational differences between the various centres, in particular, have a significant influence on the time taken until discharge. The findings thus highlight that, in addition to medical diagnosis, the processes within A&E departments are crucial for prompt care.
Clinical diagnostic pathways: crucial for rapid and safe decisions
These two studies represent the latest findings from ongoing research at the Department of Emergency Medicine at MedUni Vienna, which aims to support patients and clinicians in the rapid and safe diagnosis of potentially life-threatening situations.
“In the interests of patients, healthcare professionals and the healthcare system as a whole, we need evidence-based diagnostic pathways that are both rapid and reliable,” says Dominik Roth, national principal investigator for both studies and head of the Clinical Pathways & Health Services Research unit at the Department of Emergency Medicine at MedUni Vienna. “As part of projects currently underway, we are working to personalise these pathways even further to enable truly individualised decision-making in collaboration with patients,” says Roth.
Publications: The Lancet
Safety and efficacy of the 0/1-hour pathway for myocardial infarction in the emergency department: an international pragmatic stepped-wedge, cluster-randomised, controlled trial.
Boeddinghaus J. et al., on behalf of the PRESC1SE-MI investigators.
https://doi.org/10.1016/S0140-6736(26)01654-5
Performance of 0/1-hour versus 0/3-hour pathways in patients with suspected myocardial infarction. A systematic review and individual participant data meta-analysis of 5 randomised controlled trials.
Boeddinghaus J. et al., on behalf of the Global 0/1-hour Consortium.
https://doi.org/10.1016/S0140-6736(26)01767-8