Rapid testing for heart attacks does not reduce length of emergency department stay

Key takeaways

• Biomarker testing is used to rule in/out a myocardial infarction in patients who present to the emergency department (ED).

• One-hour testing was found to be noninferior to 3-hour testing for the primary safety endpoint but neither reduced length of ED stay nor increased direct discharge from the ED.

• The study confirms the safety of the more rapid diagnostic pathway but does not support the widespread assumption that earlier re-testing leads to accelerated patient care.

Munich, Germany - 29 August 2026: A rapid pathway for diagnosing heart attacks in the emergency department (ED) was as safe as a slower pathway but neither reduced the length of time patients spent in the ED nor increased direct discharge from the ED. These were the main findings of the PRESC1SE-MI trial and an independent participant data meta-analysis of all randomised trials presented in a Hot Line session today at ESC Congress 2026. [ 1,2] The findings were published simultaneously in The Lancet .

With more than 30 million patients worldwide presenting to the ED with suspected myocardial infarction (MI) annually, accurate methods to rapidly rule in or rule out an MI are essential to ensure timely treatment for those who need it, while helping to reduce overcrowding in ED.

Co-Principal Investigator of the PRESC1SE-MI trial, Professor Jasper Boeddinghaus from University Hospital Basel, Switzerland, and University Hospital Bonn, Germany, explained the rationale for the research: " We previously developed a diagnostic pathway, called the 0/1-hour pathway, that combines clinical assessment with two measurements of a sensitive marker for heart damage, cardiac troponin, taken one hour apart. The 0/1-hour pathway was developed to speed up diagnosis compared with the standard of measuring troponin three hours apart. The results of prospective studies led to the 0/1-hour pathway being recommended in ESC Clinical Practice Guidelines. 3 " However, Professor Boeddinghaus noted that there remains uncertainty regarding the safety and efficacy of the 0/1-hour pathway, which has led many hospitals not to adopt the new approach. "We conducted the PRESC1SE-MI trial to determine whether implementation of the 0/1-hour pathway, as compared with continued use of the 0/3-hour pathway, provided similar safety while reducing ED length of stay across diverse healthcare systems," he said.

PRESC1SE-MI was a stepped-wedge, cluster-randomised trial conducted at 20 hospitals in 11 countries.[ 1] In total, 67,624 consecutive patient presentations to the ED with suspected MI were analysed.

The occurrence of the co-primary safety outcome of death from any cause or new type 1 MI within 30 days with the 0/1-hour pathway was noninferior to the 0/3-hour pathway (1.1% and 1.2%, respectively; adjusted odds ratio [OR] 0.93; 95% confidence interval [CI] 0.77 to 1.13; p value for noninferiority <0.001).

The co-primary efficacy outcome - the length of stay in the ED - was not reduced with the 0/1-hour pathway. The median ED length of stay was 309 minutes in both groups (p=0.65).

Also presented at the congress was a meta-analysis of individual participant data from the PRESC1SE-MI trial and all other available randomised trials that have evaluated the 0/1-hour pathway vs. standard pathways.[ 2] Across five trials and 110,933 patient presentations, the 0/1-hour pathway provided similar safety to standard care but neither reduced ED length of stay nor increased direct discharge from the ED.

Summing up the results overall, Professor Boeddinghaus said: "These findings are important to healthcare providers worldwide as they contradict current assumptions that implementing 0/1-hour testing improves patient management in the ED. It seems that other processes - including specialist review, admissions workflow and bed availability - may have a greater influence on ED length of stay than the testing strategy alone. Approaches such as integrating the 0/1-hour pathway into electronic healthcare records as a clinical decision-support tool may be beneficial to bring the benefits of rapid testing to patients and the healthcare system as a whole."

ENDS