RAPID heart attack testing in patients with suspected myocardial infarction did not reduce emergency department length of stay despite demonstrating comparable safety to standard testing pathways, according to findings from the PRESC1SE-MI trial presented during the European Society of Cardiology (ESC) Congress 2026.
Accurate and timely diagnosis of myocardial infarction remains a priority in emergency care, particularly given the large number of patients presenting with suspected acute coronary events
The PRESC1SE-MI trial assessed whether a 0/1-hour diagnostic pathway, based on clinical assessment and two cardiac troponin measurements taken one hour apart, could safely accelerate patient management compared with the conventional 0/3-hour pathway.
The stepped-wedge, cluster-randomised trial was conducted across 20 hospitals in 11 countries and included 67,624 consecutive emergency department presentations for suspected myocardial infarction.
Researchers compared the safety and effectiveness of the two pathways in routine clinical practice.
The study met its co-primary safety endpoint, demonstrating noninferiority of the 0/1-hour pathway.
Death from any-cause or new type 1 myocardial infarction within 30 days occurred in 1.1% of presentations managed with the rapid pathway versus 1.2% with the standard pathway.
Despite these reassuring safety findings, the co-primary efficacy endpoint was not achieved.
Median emergency department length of stay was identical in both groups at 309 minutes, indicating that earlier repeat troponin testing alone did not translate into faster patient throughput.
Researchers also presented an individual participant data meta-analysis incorporating the PRESC1SE-MI trial and all other available randomised studies comparing the 0/1-hour pathway with standard care.
Across five trials involving 110,933 patient presentations, the rapid testing strategy demonstrated similar safety outcomes to standard pathways.
However, it again failed to reduce emergency department length of stay or increase direct discharge from the emergency department.
The findings challenge the common assumption that faster troponin testing automatically improves emergency department efficiency.
Researchers suggested that factors such as specialist review processes, admission workflows and bed availability may exert a greater influence on patient flow than diagnostic testing strategies alone.
They also noted that integrating the 0/1-hour pathway into electronic healthcare records as a clinical decision support tool may help maximise the benefits of rapid testing for patients and healthcare systems.
Boeddinghaus J et al. 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. Lancet. 2026;DOI:10.1016/S0140-6736(26)01654-5.
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