Key result
Prehospital hs-cTnI testing linked to a ~6% reduction in ED attendances versus standard care.
Why the study?
Prehospital point-of-care hs-cTnI may support earlier triage of adults with suspected ACS, but its short-term economic consequences compared with standard ED-based care in France were unassessed.
Does prehospital point-of-care high-sensitivity cardiac troponin I testing reduce prehospital-and-ED costs and ED attendances in adults with suspected acute coronary syndrome?
Cohort (n=737)
Double-blind
Yes
Does prehospital point-of-care high-sensitivity cardiac troponin I testing reduce prehospital-and-ED costs and ED attendances in adults with suspected acute coronary syndrome?
Absolute Risk Reduction: 5.8 (95% CI 2.4–9.2)
Absolute Event Rate: 90.9% vs 96.7%
Absolute Risk Reduction: 5.8%
p-value: p=<0.001
A prehospital point-of-care high-sensitivity troponin I testing strategy is associated with fewer emergency department attendances, shorter lengths of stay, and lower short-term costs compared to standard care for patients with suspected acute coronary syndrome.
May reduce ED attendances and short-term costs in suspected ACS; hypothesis-generating and requires RCTs before practice change.
Prehospital point-of-care high-sensitivity cardiac troponin I (hs-cTnI) may support earlier triage of adults with suspected acute coronary syndrome (ACS). We assessed its short-term economic consequences compared with standard emergency department (ED)-based care in France. We developed a decision-analytic, continuous-time semi-Markov model over a 24-hour horizon using individual patient data from the prospective, multicentre, double-blinded cohort study (VALIDATE) conducted across four French hospitals (July 2021-May 2024; n = 737). The reference analysis adopted a restricted prehospital-and-ED perspective covering measured medical and paramedical resources from first emergency medical service contact through ED disposition (states 1–3). A complementary database audit searched for patients recorded with less than 24 h of follow-up in an extended “prehospital, emergency department and hospital” setting. None were identified; inpatient, intensive care unit (ICU), coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) costs were therefore excluded from the reference-case totals. The initial hs-cTnI H0 sample was obtained before hospital arrival, whereas subsequent H1 or H3 samples, when required, were intended to be collected after arrival. Costs were reported in 2025 euros. Sampling uncertainty was assessed using 1,000 non-parametric bootstrap replications and scenario analyses examined clinically relevant subgroups (> 3 h since symptom onset; availability of a prehospital HEART score). Among 737 participants (mean age 65.4 years; 58.8% men), 77 (10.4%) had non-ST-segment elevation myocardial infarction. ED attendance was lower with hs-cTnI than with standard care (90.9% [95% CI 88.6–92.8] vs. 96.7% [95% CI 95.2–97.8]; absolute difference − 5.8% points [95% CI − 9.2 to − 2.4]; P < 0.001). Among ED attendees, mean ED length of stay was 1.63 h versus 2.76 h ( P < 0.001). Mean prehospital-and-ED cost per patient was €185.24 with hs-cTnI and €268.55 with standard care, a saving of €83.31 ([95% CI 70.81–96.60]; P < 0.001). Within the restricted 24-hour prehospital-and-ED perspective supported by the available patient-level data, a strategy beginning with prehospital hs-cTnI testing was associated with fewer ED attendances, shorter ED stays and lower costs. Longer-term evaluations are planned because these findings do not establish system-wide for inpatient, wider organisational, patient and societal costs. The VALIDATE study is registered with ClinicalTrials.gov (NCT04950244).
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Maunoury et al. (2026) conducted a cohort in Suspected acute coronary syndrome (n=737). Prehospital point-of-care high-sensitivity cardiac troponin I (hs-cTnI) testing vs. Standard emergency department care was evaluated on Emergency department attendance (absolute difference -5.8 percentage points, 95% CI -9.2 to -2.4, p=<0.001). Prehospital high-sensitivity cardiac troponin I testing reduced emergency department attendances by 5.8 percentage points and saved an average of €83.31 per patient compared to standard care.
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