Value of Prehospital Troponin Assessment in Suspected Non-ST-Elevation Acute Coronary Syndrome
Section snippets
Methods
This prospective observational cohort study, the second phase of the Famous Triage project,2, 3 was performed between January 2016 and July 2017. Patients from Isala and Deventer hospital were included which are tertiary and secondary care hospitals in the Netherlands. The study involved 33 emergency medical services vehicles from 2 regional ambulance services (RAV IJsselland and Witte Kruis ambulancezorg) staffed by approximately 110 paramedics. The original aim of the second phase of the
Results
From January 2016 to July 2017, a total of 823 patients were considered eligible by paramedics. A complete HEART score was not available in 120 patients (15%) due to missing troponin results (87 patients) and/or incomplete registration of HEART scores (41 patients). Main reasons for the absence of a troponin result were device error, unavailability of testing strips or inability to obtain blood. A total of 3 patients with a complete HEART score were lost to follow-up. 700 patients (83%) with a
Discussion
We demonstrated that in suspected NSTE-ACS, the prehospital troponin component within the HEART score has important value in predicting MACE within 45 days. The HEART score was designed to incorporate a systematic and integrated approach of patients with suspected non-STEMI.22 Famous triage is the first study in which the complete HEART score is investigated in a prehospital setting.2, 3,23 The first phase of this study was performed with retrospective HEART assessment and hs-TnT.2 The current,
Acknowledgment
We thank Sonja Nijhoff, Ben Nijenkamp and Gert van Putten for data collection. We thank Wouter Jansen Klomp and Esther van ‘t Riet for assistance in data analysis.
Disclosures
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or
Ethical Approval
The study was approved by the Regional Medical Ethics Board on the 20th September 2013.
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Cited by (23)
Diagnostic Accuracy of Clinical Pathways for Suspected Acute Myocardial Infarction in the Out-of-Hospital Environment
2023, Annals of Emergency MedicineEMS blood collection from patients with acute chest pain reduces emergency department length of stay
2021, American Journal of Emergency MedicineCitation Excerpt :However, the demographics and prevalence of risk factors among our cohort are similar to other EMS cohorts with acute chest pain [22,24]. Although our 30-day MACE rate of 21.0% is higher than most ED cohorts, it is similar to other studies focused on EMS chest pain care [25-27]. The time of patient's chest pain onset relative to calling 911 and paramedic patient contact was not collected.
The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A Prospective Cohort Study
2021, Annals of Emergency MedicineCitation Excerpt :We demonstrated that the HEART score can be incorporated into paramedic practice and confirmed previous work19 showing that out-of-hospital point-of-care troponin testing improves discrimination over the HEAR components alone but remains lower than has been reported in patient populations attending the ED.35 In this study, HEART score less than or equal to 3 identified 30% of patients as low risk, comparable to that in inhospital studies of the HEART score35 and higher than that in a previous out-of-hospital cohort.19,20 However, HEART score less than or equal to 3 did not confer significant benefit over HEAR score less than or equal to 3, and sensitivity and negative predictive value did not approach recognized thresholds of 99%36 and 99.5%,31 respectively, for a safe rule-out strategy.
Advances in point-of-care testing for cardiovascular diseases
2021, Advances in Clinical ChemistryCitation Excerpt :Moreover, this is compounded by inferior performance characteristics of cTn POC assays when compared to their laboratory assay counterparts [39]. Van Dongen et al. encountered this issue when measuring cTnT in stationary ambulances using Roche's cobas h232 POC system approximately 85 min following symptom onset [40]. The authors could adequately determine NSTEMI in high risk patients, however they recommended acquiring a second cTnT measurement 120 min or more from symptom onset to further elucidate the severity of a patient's condition.
Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule out Acute Myocardial Infarction: A Systematic Review
2020, Prehospital and Disaster MedicinePrehospital Comparison of the HEAR and HE-MACS Scores for 30-Day Adverse Cardiac Events
2024, Prehospital Emergency Care
Funding: The study was funded by Isala Research Fund. Roche diagnostics provided POC devices and POC strips. Researchers were independent of funders and funders were not involved in writing this research or performing analyses.