Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score

• Published in: European heart journal. Acute cardiovascular care Vol. 7; no. 2; pp. 102 - 110
• Main Authors: Ishak, Maycel, Ali, Danish, Fokkert, Marion J, Slingerland, Robbert J, Tolsma, Rudolf T, Badings, Erik, van der Sluis, Aize, van Eenennaam, Fred, Mosterd, Arend, ten Berg, Jurriën M, van ’t Hof, Arnoud WJ
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2018
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - epidemiology; Aged; Biomarkers - blood; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Electrocardiography; Female; Humans; Incidence; Male; Middle Aged; Netherlands - epidemiology; Non-ST Elevated Myocardial Infarction - blood; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - epidemiology; Prospective Studies; Retrospective Studies; Risk Assessment - methods; Risk Factors; Triage - methods; Troponin T - blood; modified HEART score; Pre-hospital triage; highly sensitive troponin; chest pain; non-ST-segment elevation acute coronary syndrome; acute myocardial infarction
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1177/2048872616687116

Background: The first study of the FamouS Triage project investigates the feasibility of ruling out a myocardial infarction in pre-hospital chest pain patients without electrocardiographic ST-segment elevation by using the modified HEART score at the patient’s home, incorporating only a single highly sensitive troponin T measurement. Methods: A venous blood sample was drawn in the ambulance from 1127 consecutive chest pain patients for measurement of the pre-hospital highly sensitive troponin T levels, in order to establish a pre-hospital HEART score (i.e. the modified HEART score) and evaluate the possibility of triage at the patient’s home. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) i.e. acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or death within 30 days after initial presentation. Results: Two hundred and six patients (18%) developed a MACE during 30 days of follow-up. Thirty-six per cent of the patients (n=403) had a low modified HEART score (0–3 points) and none of them developed a MACE during follow-up. Forty-four per cent of the patients (n=494) had an intermediate modified HEART score (4–6 points) and 18% of them developed a MACE. Twenty per cent of the patients (n=230) had a high modified HEART score (7–10 points) of which 52% developed a MACE during follow-up. Conclusion: It seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score. TRIAL ID: NTR4205. Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.