Why the study?
While the ESC 2020 guidelines provide an in-hospital risk-stratification algorithm for NSTEMI, out-of-hospital management is not codified.
Does point-of-care high-sensitivity cardiac troponin-I predict high-risk stratification in out-of-hospital NSTEMI patients managed by EMS?
Does point-of-care high-sensitivity cardiac troponin-I predict high-risk stratification in out-of-hospital NSTEMI patients managed by EMS?
The use of point-of-care high-sensitivity troponin in the prehospital EMS setting, combined with clinical and ECG criteria, effectively predicts high-risk NSTEMI and can optimize triage to appropriate care pathways.
Supports prehospital troponin for EMS NSTEMI risk stratification; leaves open outcome impact in prospective trials.
Introduction: The European Society of Cardiology (ESC) 2020 guidelines propose an algorithm for in-hospital management of non-ST-elevation myocardial infarction (NSTEMI) based on risk stratification according to clinical, electrocardiographic, and biological data. However, out-of-hospital management is not codified. Study Objective: The objective of the present study was to evaluate the role of high-sensitivity cardiac troponin-I in out-of-hospital management of NSTEMI by Emergency Medical Services (EMS). Methods: This monocentric, retrospective, observational study analyzed the files of all patients having received a troponin assay in the EMS of Beaujon University Hospital, AP-HP (Paris region, France) from January 1, 2020 through December 31, 2020. Patients were classified as low risk, high risk, or very high risk according to the ESC 2020 algorithm at the time of their hospital treatment. The relationship between troponin in point-of-care and risk level according to time to onset of pain was analyzed using logistic regression. A search for predictors of risk level was performed using multivariate analysis. A P value <.05 was considered significant. Results: Out of 309 patients in the file, 233 were included. Men were 61% and the median age was 63 years. A positive troponin assay was associated with high-risk or very high-risk stratification regardless of the time to onset of pain (P <.0001). Predictive factors for being classified as high or very high risk in hospital were: a history of atrial fibrillation (P = .03), electrocardiogram (ECG) modifications such as negative T wave or ST-segment depression (P <.0001), and positive troponin (P <.0001). Conclusion: The use of point-of-care troponin in EMS, combined with clinical and electrical criteria, allows risk stratification of NSTEMI patients from the prehospital management stage and optimization of referral to an appropriate care pathway. Patients classified as low risk should be referred to the emergency department (ED) and patients classified as high risk or very high risk to the cardiac intensive care unit or percutaneous coronary intervention (PCI) center.
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Pavlovsky et al. (2022) studied this question.
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