Universal criteria for myocardial infarction (MI) risk stratification could simplify and standardize emergency care. Findings presented at the European Society of Cardiology (ESC) Congress 2025 evaluated the performance of the 3C algorithm—a common change criteria approach independent of hs-cTn assay type.

Published in the European Heart Journal, the study pooled data from 5,011 patients across two prospective cohorts in Germany and New Zealand. Patients presenting with suspected MI underwent serial hs-cTn testing using three different assays. The 3C algorithm applied universal change criteria: >|3| ng/L for values <10 ng/L, >|30|% for 10–100 ng/L, and >|15|% for >100 ng/L.

Diagnostic performance of the 3C algorithm was comparable to ESC 0/1h and 0/2h rule-in and rule-out algorithms. Sensitivity, specificity, and predictive values were similar across all assays, with no net reclassification advantage for either approach. Notably, the 3C algorithm identified additional MI cases initially ruled out by ESC criteria.

These results suggested that the 3C algorithm was a robust, assay-agnostic alternative for MI risk stratification in emergency settings, supporting broader clinical applicability and simplifying decision-making.