48The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI

Background: Triage of patients with chest pain usually occurs in the hospital emergency room (ER). It has been shown that the HEART-score offers a simple and quick risk-stratification tool for these patients. Additionally the high-sensitive Troponin T (hs-cTnT) provides a great diagnostic accuracy and detection of acute myocardial infarction. Purpose: This study investigated whether a pre-hospital chest pain triage is feasible in terms of early ruling out acute coronary syndrome (ACS) in the ambulance by ambulance nurses using a single hs-cTnT measurement as to establish the HEART-score. Methods: This is the first, exploratory phase, of two prospective, non-randomized, observational cohort studies, prior to additional training of ambulance nurses. Patients with acute onset chest pain were prospectively evaluated at first medical contact by ambulance nurses including the HEART-score and a hs-cTnT assessment. Follow-up was performed at 30 days in terms of MACE. Results: A pre-hospital HEART-score was determined in 600 chest pain patients without ST-segment elevation. Mean age was 70 years, 38% was female. 140 Patients (23.3%) were classified as low risk, 341 (56.8%) as intermediate and 119 (19.8%) as high risk patients. This corresponded with a significant (p = <0.001) difference in MACE within 30 days of 2.9%; 18.8% and 45.4%, respectively. Also, the pre-hospital HEART-score was a strong predictor of the individual factors of MACE: ACS (p = <0.001), PCI (p=0.001), CABG (p<0.001), death (p=0.02). There were no deaths in the low risk group.