Value of Prehospital Troponin Assessment in Suspected Non-ST-Elevation Acute Coronary Syndrome
There is an increasing awareness that prehospital risk stratification in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) is important. The HEART score accurately identifies patients at low risk and is nowadays fully assessable outside the hospital after the development of...
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Published in | The American journal of cardiology Vol. 122; no. 10; pp. 1610 - 1616 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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15.11.2018
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Abstract | There is an increasing awareness that prehospital risk stratification in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) is important. The HEART score accurately identifies patients at low risk and is nowadays fully assessable outside the hospital after the development of point-of-care (POC) troponin tests. However, the added value of the troponin component to the prehospital HEART score has not yet been assessed. This is a prospective cohort study including 700 patients with suspected NSTE-ACS in which prehospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as HEAR or HEART score ≦3. Troponin was measured by a POC troponin T Test device (Roche Cobas h232). Troponin <40 ng/l scored 0 point, troponin ≥40 ng/l scored 2 points. Primary end point was major adverse cardiac events (MACE) within 45 days after inclusion. Mean HEAR score was 4.5 ± 1.6, mean HEART score was 4.7 ± 1.7. Using the HEAR score, a total of 183 patients (26%) were stratified as low risk, whereas using the HEART score, 172 patients (25%) were stratified as low risk (p = 0.001). In both low-risk groups, there were no deaths within 45 days. Using HEAR, MACE occurred in 13 patients (7%) in the low-risk group, whereas using HEART, MACE occurred in 5 patients in the low-risk group (3%, p <0.001). The use of HEART (Area under the curve 0.74) obtained a higher predictive value compared to HEAR (Area under the curve 0.65, p <0.001) for MACE. In conclusion, in patients with suspected NSTE-ACS, the prehospital troponin component of the HEART score has important added predictive value. |
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AbstractList | There is an increasing awareness that prehospital risk stratification in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) is important. The HEART score accurately identifies patients at low risk and is nowadays fully assessable outside the hospital after the development of point-of-care (POC) troponin tests. However, the added value of the troponin component to the prehospital HEART score has not yet been assessed. This is a prospective cohort study including 700 patients with suspected NSTE-ACS in which prehospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as HEAR or HEART score ≦3. Troponin was measured by a POC troponin T Test device (Roche Cobas h232). Troponin <40 ng/l scored 0 point, troponin ≥40 ng/l scored 2 points. Primary end point was major adverse cardiac events (MACE) within 45 days after inclusion. Mean HEAR score was 4.5 ± 1.6, mean HEART score was 4.7 ± 1.7. Using the HEAR score, a total of 183 patients (26%) were stratified as low risk, whereas using the HEART score, 172 patients (25%) were stratified as low risk (p = 0.001). In both low-risk groups, there were no deaths within 45 days. Using HEAR, MACE occurred in 13 patients (7%) in the low-risk group, whereas using HEART, MACE occurred in 5 patients in the low-risk group (3%, p <0.001). The use of HEART (Area under the curve 0.74) obtained a higher predictive value compared to HEAR (Area under the curve 0.65, p <0.001) for MACE. In conclusion, in patients with suspected NSTE-ACS, the prehospital troponin component of the HEART score has important added predictive value. |
Author | van ‘t Hof, Arnoud W.J. Ottervanger, Jan Paul van der Sluis, Aize Slingerland, Robbert J. Badings, Erik A. Tolsma, Rudolf T. van Dongen, Dominique N. Fokkert, Marion J. |
Author_xml | – sequence: 1 givenname: Dominique N. orcidid: 0000-0002-8630-080X surname: van Dongen fullname: van Dongen, Dominique N. email: d.n.van.dongen@isala.nl, dominiquevandongen@hotmail.com organization: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands – sequence: 2 givenname: Marion J. surname: Fokkert fullname: Fokkert, Marion J. organization: Department of Clinical Chemistry, Isala Hospital, Zwolle, The Netherlands – sequence: 3 givenname: Rudolf T. surname: Tolsma fullname: Tolsma, Rudolf T. organization: Regional Ambulance Service IJsselland, Zwolle, The Netherlands – sequence: 4 givenname: Erik A. surname: Badings fullname: Badings, Erik A. organization: Department of Cardiology, Deventer Hospital, Deventer, The Netherlands – sequence: 5 givenname: Aize surname: van der Sluis fullname: van der Sluis, Aize organization: Department of Cardiology, Deventer Hospital, Deventer, The Netherlands – sequence: 6 givenname: Robbert J. surname: Slingerland fullname: Slingerland, Robbert J. organization: Regional Ambulance Service IJsselland, Zwolle, The Netherlands – sequence: 7 givenname: Arnoud W.J. surname: van ‘t Hof fullname: van ‘t Hof, Arnoud W.J. organization: Department of Cardiology, MUMC, Maastricht, The Netherlands – sequence: 8 givenname: Jan Paul surname: Ottervanger fullname: Ottervanger, Jan Paul organization: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands |
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SubjectTerms | Acute Coronary Syndrome - blood Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology Acute coronary syndromes Age Angina pectoris Biomarkers - blood Body mass index Calcium-binding protein Coronary vessels Diabetes Electrocardiography Emergency medical care Emergency Medical Services Family medical history Follow-Up Studies Heart Heart attacks Heart surgery Hospitals Humans Hypertension Incidence Ischemia Netherlands - epidemiology Paramedics Patients Predictive Value of Tests Prospective Studies Risk assessment Risk Assessment - methods Risk Factors Risk groups Stroke Survival Rate - trends Troponin Troponin - blood Troponin T |
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Title | Value of Prehospital Troponin Assessment in Suspected Non-ST-Elevation Acute Coronary Syndrome |
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