Key result
Pre-hospital point-of-care troponin measurement can result in early detection of myocardial infarction and reduce diagnosis-to-treatment time in low-risk patients with initially non-suspicious ECGs.
Why the study?
Pre-hospital protocols to rule out ACS are lacking, requiring patients with suspected ACS to be transported to the emergency department.
Does pre-hospital point-of-care troponin measurement improve early detection of acute coronary syndrome in patients with chest pain?
Case Report (n=1)
Does pre-hospital point-of-care troponin measurement improve early detection of acute coronary syndrome in patients with chest pain?
Pre-hospital point-of-care troponin measurement can facilitate early detection of myocardial infarction and reduce diagnosis-to-treatment time, even in patients initially classified as low-risk based on symptoms and ECG.
May support pre-hospital troponin testing in low-risk chest pain; hypothesis-generating and should not yet change practice.
In the majority of patients with chest pain, an acute coronary syndrome (ACS) can be ruled out. However, early recognition of an ACS is required in order to start treatment as soon as possible and reduce risks associated with myocardial ischaemia. Because of the lack of pre-hospital protocols to rule out an ACS, patients with a suspected ACS are transported to the emergency department, where the HEART score can be used to estimate the risk of major adverse cardiac events (MACE). Patients with a low HEART score have a low risk of MACE. A point-of-care (POC) troponin measurement enables ambulance paramedics to calculate the HEART score in the pre-hospital setting. POC troponin measurement and HEART score assessment have several potential advantages, including early recognition of an ACS and identification of high-risk patients before hospital arrival. Moreover, pre-hospital rule-out of an ACS could prevent unnecessary emergency department visits. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin value to the general practitioner are currently being investigated in the ARTICA randomised trial. This point-of-view article demonstrates one of the potential advantages of early detection of an ACS.
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Aarts et al. (2020) conducted a case report in Chest pain / suspected acute coronary syndrome (n=1). Pre-hospital point-of-care troponin measurement vs. Standard care (immediate transport to emergency department) was evaluated. Pre-hospital point-of-care troponin measurement can result in early detection of myocardial infarction and reduce diagnosis-to-treatment time in low-risk patients with initially non-suspicious ECGs.
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