Accuracy of pre-hospital HEART score risk classification using point of care versus high sensitive troponin in suspected NSTE-ACS
Pre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classific...
Saved in:
| Published in | The American journal of emergency medicine Vol. 38; no. 8; pp. 1616 - 1620 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Philadelphia
Elsevier Inc
01.08.2020
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0735-6757 1532-8171 1532-8171 |
| DOI | 10.1016/j.ajem.2019.158448 |
Cover
| Abstract | Pre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classification using point of care troponin versus high sensitive troponin.
In 689 consecutive patients with suspected NSTE-ACS, point of care troponin and laboratory high-sensitive troponin were measured in pre-hospital derived blood. For every patient the HEART score with both point of care troponin (HEART-POC) and high sensitive troponin (HEART-hsTnT) was determined. Endpoint was MACE within 45 days.
Mean age was 64 (SD ± 14), 163 (24%) patients were considered low-risk by HEART-hsTnT and 170 (25%) by HEART-POC. MACE was observed in 17%. Although high sensitive versus POC troponin scoring was different in 130 (19%) of patients, in 678 (98%) patients risk classification in low versus intermediate-high risk was similar. The predictive values of HEART-POC versus HEART-HsTnT was similar (AUC 0.75 versus 0.76, p = 0.241).
Although high sensitive versus POC troponin scoring was dissimilar in one fifth of patients, this resulted in different patient risk classification in only 2 percent of patients. Therefore POC troponin measurement suffices for pre-hospital risk stratification of suspected NSTE-ACS. |
|---|---|
| AbstractList | IntroductionPre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classification using point of care troponin versus high sensitive troponin.MethodsIn 689 consecutive patients with suspected NSTE-ACS, point of care troponin and laboratory high-sensitive troponin were measured in pre-hospital derived blood. For every patient the HEART score with both point of care troponin (HEART-POC) and high sensitive troponin (HEART-hsTnT) was determined. Endpoint was MACE within 45 days.ResultsMean age was 64 (SD ± 14), 163 (24%) patients were considered low-risk by HEART-hsTnT and 170 (25%) by HEART-POC. MACE was observed in 17%. Although high sensitive versus POC troponin scoring was different in 130 (19%) of patients, in 678 (98%) patients risk classification in low versus intermediate-high risk was similar. The predictive values of HEART-POC versus HEART-HsTnT was similar (AUC 0.75 versus 0.76, p = 0.241).ConclusionAlthough high sensitive versus POC troponin scoring was dissimilar in one fifth of patients, this resulted in different patient risk classification in only 2 percent of patients. Therefore POC troponin measurement suffices for pre-hospital risk stratification of suspected NSTE-ACS. Pre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classification using point of care troponin versus high sensitive troponin.INTRODUCTIONPre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classification using point of care troponin versus high sensitive troponin.In 689 consecutive patients with suspected NSTE-ACS, point of care troponin and laboratory high-sensitive troponin were measured in pre-hospital derived blood. For every patient the HEART score with both point of care troponin (HEART-POC) and high sensitive troponin (HEART-hsTnT) was determined. Endpoint was MACE within 45 days.METHODSIn 689 consecutive patients with suspected NSTE-ACS, point of care troponin and laboratory high-sensitive troponin were measured in pre-hospital derived blood. For every patient the HEART score with both point of care troponin (HEART-POC) and high sensitive troponin (HEART-hsTnT) was determined. Endpoint was MACE within 45 days.Mean age was 64 (SD ± 14), 163 (24%) patients were considered low-risk by HEART-hsTnT and 170 (25%) by HEART-POC. MACE was observed in 17%. Although high sensitive versus POC troponin scoring was different in 130 (19%) of patients, in 678 (98%) patients risk classification in low versus intermediate-high risk was similar. The predictive values of HEART-POC versus HEART-HsTnT was similar (AUC 0.75 versus 0.76, p = 0.241).RESULTSMean age was 64 (SD ± 14), 163 (24%) patients were considered low-risk by HEART-hsTnT and 170 (25%) by HEART-POC. MACE was observed in 17%. Although high sensitive versus POC troponin scoring was different in 130 (19%) of patients, in 678 (98%) patients risk classification in low versus intermediate-high risk was similar. The predictive values of HEART-POC versus HEART-HsTnT was similar (AUC 0.75 versus 0.76, p = 0.241).Although high sensitive versus POC troponin scoring was dissimilar in one fifth of patients, this resulted in different patient risk classification in only 2 percent of patients. Therefore POC troponin measurement suffices for pre-hospital risk stratification of suspected NSTE-ACS.CONCLUSIONAlthough high sensitive versus POC troponin scoring was dissimilar in one fifth of patients, this resulted in different patient risk classification in only 2 percent of patients. Therefore POC troponin measurement suffices for pre-hospital risk stratification of suspected NSTE-ACS. Pre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than high sensitive troponin measurement which is used in the hospital setting. In this study we compared pre-hospital HEART-score risk classification using point of care troponin versus high sensitive troponin. In 689 consecutive patients with suspected NSTE-ACS, point of care troponin and laboratory high-sensitive troponin were measured in pre-hospital derived blood. For every patient the HEART score with both point of care troponin (HEART-POC) and high sensitive troponin (HEART-hsTnT) was determined. Endpoint was MACE within 45 days. Mean age was 64 (SD ± 14), 163 (24%) patients were considered low-risk by HEART-hsTnT and 170 (25%) by HEART-POC. MACE was observed in 17%. Although high sensitive versus POC troponin scoring was different in 130 (19%) of patients, in 678 (98%) patients risk classification in low versus intermediate-high risk was similar. The predictive values of HEART-POC versus HEART-HsTnT was similar (AUC 0.75 versus 0.76, p = 0.241). Although high sensitive versus POC troponin scoring was dissimilar in one fifth of patients, this resulted in different patient risk classification in only 2 percent of patients. Therefore POC troponin measurement suffices for pre-hospital risk stratification of suspected NSTE-ACS. |
| Author | Ottervanger, Jan Paul van der Sluis, Aize Slingerland, Robbert J. Badings, Erik A. Tolsma, Rudolf T. van Dongen, Dominique N. Fokkert, Marion J. van 't Hof, Arnoud W.J. |
| Author_xml | – sequence: 1 givenname: Dominique N. surname: van Dongen fullname: van Dongen, Dominique N. email: d.n.van.dongen@isala.nl 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: Ambulance Service IJsselland, Zwolle, the Netherlands – sequence: 4 givenname: Aize surname: van der Sluis fullname: van der Sluis, Aize organization: Department of Cardiology, Deventer Hospital, Deventer, the Netherlands – sequence: 5 givenname: Robbert J. surname: Slingerland fullname: Slingerland, Robbert J. organization: Department of Clinical Chemistry, Isala Hospital, Zwolle, the Netherlands – sequence: 6 givenname: Erik A. surname: Badings fullname: Badings, Erik A. organization: Department of Cardiology, Deventer Hospital, Deventer, the Netherlands – sequence: 7 givenname: Arnoud W.J. surname: van 't Hof fullname: van 't Hof, Arnoud W.J. organization: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands – sequence: 8 givenname: Jan Paul surname: Ottervanger fullname: Ottervanger, Jan Paul organization: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands |
| BookMark | eNqFkU1rGzEQhkVJoU7aP9CToJde1tHXfrj0YozbBEILjXsW8uwolrOWttKuwcf-82rrnnxIQTAHPc8wvO81ufLBIyHvOZtzxqvb_dzs8TAXjC_mvGyUal6RGS-lKBpe8ysyY7Usi6ou6zfkOqU9Y5yrUs3I7yXAGA2caLC0j1jsQurdYDp6t17-2NAEISKNLj1T6ExKzjowgwuejsn5J9oH54fJBZO5I8Y0JrpzTzua0Cc3uCPSIYY-eOdpfvm7Rxiwpd8eN-tiuXp8S15b0yV892_ekJ9f1pvVXfHw_ev9avlQgOJiKAQY26AwLZcLxdlCCFtWTJXCtrbZ2lYKrFtlLagWmgqbWgJseQ3MMmlltZU35ON5bx_DrxHToA8uAXad8RjGpIXkUlaCl1VGP1yg-zBGn6_TQomqYZz9pcSZghhSimh1H93BxJPmTE-t6L2eWtFTK_rcSpaaCwly2lOgQzSue1n9fFYxp3R0GHUChx6wdTFHqtvgXtY_XejQOZ_b7J7x9D_5D03lvqc |
| CitedBy_id | crossref_primary_10_1007_s12471_022_01710_x crossref_primary_10_1016_j_ajem_2022_07_053 crossref_primary_10_1093_ehjacc_zuab109 crossref_primary_10_1136_bmjopen_2023_071822 crossref_primary_10_12968_jpar_2024_0055 crossref_primary_10_1111_acem_14930 crossref_primary_10_3390_diagnostics14111100 crossref_primary_10_1136_emermed_2023_213866 crossref_primary_10_2217_fca_2023_0038 crossref_primary_10_2217_fca_2023_0049 crossref_primary_10_1007_s11739_023_03274_z crossref_primary_10_1136_emermed_2022_213003 crossref_primary_10_1136_emermed_2021_211890 crossref_primary_10_1186_s13049_025_01329_y crossref_primary_10_1007_s12471_021_01646_8 crossref_primary_10_1016_j_ajem_2021_09_079 crossref_primary_10_1136_bmjopen_2021_057305 crossref_primary_10_1111_eci_13591 crossref_primary_10_1093_ehjdh_ztae087 |
| Cites_doi | 10.1136/bmjopen-2015-010694 10.1016/j.clinbiochem.2017.01.003 10.1136/heartjnl-2015-308505 10.1136/heartjnl-2016-309270 10.1016/j.ajem.2016.10.005 10.1016/j.jacc.2014.09.016 10.1161/CIRCULATIONAHA.118.036528 10.1016/j.ijcard.2013.01.255 10.1161/CIR.0b013e31826e1058 10.1016/j.amjcard.2013.06.026 10.1161/CIRCULATIONAHA.118.036426 10.7326/M16-1600 10.7754/Clin.Lab.2016.160814 10.1093/eurheartj/ehv320 10.1161/JAHA.115.002859 10.1017/S1049023X17007154 10.1007/s40258-019-00502-6 10.1177/2048872614549738 10.1177/2048872616687116 10.1016/j.ijcard.2014.09.026 |
| ContentType | Journal Article |
| Copyright | 2019 Elsevier Inc. 2019. Elsevier Inc. Copyright © 2019 Elsevier Inc. All rights reserved. |
| Copyright_xml | – notice: 2019 Elsevier Inc. – notice: 2019. Elsevier Inc. – notice: Copyright © 2019 Elsevier Inc. All rights reserved. |
| DBID | AAYXX CITATION 3V. 7RV 7T5 7X7 7XB 88E 8FI 8FJ 8FK 8G5 ABUWG AEUYN AFKRA AZQEC BENPR CCPQU DWQXO FYUFA GHDGH GNUQQ GUQSH H94 K9. KB0 M0S M1P M2O MBDVC NAPCQ PHGZM PHGZT PJZUB PKEHL PPXIY PQEST PQQKQ PQUKI Q9U 7X8 |
| DOI | 10.1016/j.ajem.2019.158448 |
| DatabaseName | CrossRef ProQuest Central (Corporate) Nursing & Allied Health Database Immunology Abstracts Health & Medical Collection ProQuest Central (purchase pre-March 2016) Medical Database (Alumni Edition) ProQuest Hospital Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Research Library ProQuest Central (Alumni) ProQuest One Sustainability ProQuest Central UK/Ireland ProQuest Central Essentials ProQuest Central ProQuest One Community College ProQuest Central Proquest Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student ProQuest Research Library AIDS and Cancer Research Abstracts ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Database (Alumni Edition) ProQuest Health & Medical Collection Medical Database Research Library Research Library (Corporate) Nursing & Allied Health Premium Proquest Central Premium ProQuest One Academic (New) ProQuest Health & Medical Research Collection ProQuest One Academic Middle East (New) ProQuest One Health & Nursing ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central Basic MEDLINE - Academic |
| DatabaseTitle | CrossRef Research Library Prep ProQuest Central Student ProQuest One Academic Middle East (New) ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest One Health & Nursing Research Library (Alumni Edition) ProQuest Central ProQuest One Sustainability Health Research Premium Collection Health and Medicine Complete (Alumni Edition) ProQuest Central Korea Health & Medical Research Collection AIDS and Cancer Research Abstracts ProQuest Research Library ProQuest Central (New) ProQuest Medical Library (Alumni) ProQuest Central Basic ProQuest One Academic Eastern Edition ProQuest Nursing & Allied Health Source ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest Hospital Collection (Alumni) Nursing & Allied Health Premium ProQuest Health & Medical Complete ProQuest Medical Library ProQuest One Academic UKI Edition Immunology Abstracts ProQuest Nursing & Allied Health Source (Alumni) ProQuest One Academic ProQuest One Academic (New) ProQuest Central (Alumni) MEDLINE - Academic |
| DatabaseTitleList | Research Library Prep MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1532-8171 |
| EndPage | 1620 |
| ExternalDocumentID | 10_1016_j_ajem_2019_158448 S0735675719305972 |
| GroupedDBID | --- --K --M .1- .FO .GJ .~1 0R~ 123 1B1 1P~ 1RT 1~. 1~5 23M 354 4.4 457 4G. 53G 5RE 5VS 6J9 7-5 71M 7RV 7X7 88E 8F7 8FI 8FJ 8G5 8P~ 9JM A8Z AAEDT AAEDW AAIKJ AAKOC AALRI AAOAW AAQFI AAQQT AAQXK AATTM AAWTL AAXKI AAXUO AAYWO ABBQC ABFNM ABJNI ABLJU ABMAC ABMZM ABOCM ABUWG ABWVN ABXDB ACDAQ ACGFO ACGFS ACIEU ACIWK ACPRK ACRLP ACRPL ACVFH ADBBV ADCNI ADEZE ADFRT ADMUD ADNMO AEBSH AEIPS AEKER AENEX AEUPX AEUYN AEVXI AFFNX AFJKZ AFKRA AFPUW AFRAH AFRHN AFTJW AFXIZ AGCQF AGHFR AGQPQ AGUBO AGYEJ AHHHB AHMBA AIEXJ AIGII AIIUN AIKHN AITUG AJRQY AJUYK AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ ANKPU ANZVX APXCP ASPBG AVWKF AXJTR AZFZN AZQEC BENPR BKEYQ BKOJK BLXMC BNPGV BPHCQ BVXVI C45 CAG CCPQU COF CS3 DWQXO EBS EFJIC EFKBS EJD EMOBN EO8 EO9 EP2 EP3 EX3 F5P FDB FEDTE FGOYB FIRID FNPLU FYGXN FYUFA G-2 G-Q GBLVA GNUQQ GUQSH HDV HMCUK HMK HMO HVGLF HZ~ IHE J1W K-O KOM LX1 M1P M29 M2O M41 MO0 N4W N9A NAPCQ O-L O9- OAUVE OBH OB~ OHH OM0 OVD OZT P-8 P-9 P2P PC. PHGZM PHGZT PJZUB PPXIY PQQKQ PROAC PSQYO PUEGO Q38 R2- ROL RPZ SAE SDF SDG SDP SEL SES SEW SJN SPCBC SSH SSZ SV3 T5K TEORI UAP UHS UKHRP UNMZH UV1 WOW WUQ Z5R ZGI ZY1 ~G- 3V. AACTN AAIAV ABLVK ABYKQ AFCTW AFKWA AJBFU AJOXV AMFUW EFLBG ESTFP LCYCR RIG AAYXX AGRNS ALIPV CITATION 7T5 7XB 8FK H94 K9. MBDVC PKEHL PQEST PQUKI Q9U 7X8 |
| ID | FETCH-LOGICAL-c412t-2caf8e2ad139410922f560452fdf8bfd32e7d4ffc4dc86e873ccb17c0f03f36b3 |
| IEDL.DBID | AIKHN |
| ISSN | 0735-6757 1532-8171 |
| IngestDate | Thu Sep 04 19:44:31 EDT 2025 Sat Jul 26 00:57:08 EDT 2025 Tue Jul 01 03:01:08 EDT 2025 Thu Apr 24 23:08:52 EDT 2025 Fri Feb 23 02:46:50 EST 2024 Tue Aug 26 16:33:57 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 8 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c412t-2caf8e2ad139410922f560452fdf8bfd32e7d4ffc4dc86e873ccb17c0f03f36b3 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 |
| PQID | 2426801056 |
| PQPubID | 1216387 |
| PageCount | 5 |
| ParticipantIDs | proquest_miscellaneous_2313362156 proquest_journals_2426801056 crossref_primary_10_1016_j_ajem_2019_158448 crossref_citationtrail_10_1016_j_ajem_2019_158448 elsevier_sciencedirect_doi_10_1016_j_ajem_2019_158448 elsevier_clinicalkey_doi_10_1016_j_ajem_2019_158448 |
| ProviderPackageCode | CITATION AAYXX |
| PublicationCentury | 2000 |
| PublicationDate | August 2020 2020-08-00 20200801 |
| PublicationDateYYYYMMDD | 2020-08-01 |
| PublicationDate_xml | – month: 08 year: 2020 text: August 2020 |
| PublicationDecade | 2020 |
| PublicationPlace | Philadelphia |
| PublicationPlace_xml | – name: Philadelphia |
| PublicationTitle | The American journal of emergency medicine |
| PublicationYear | 2020 |
| Publisher | Elsevier Inc Elsevier Limited |
| Publisher_xml | – name: Elsevier Inc – name: Elsevier Limited |
| References | Mahler, Lenoir, Wells (b0120) 2018; 138 Amsterdam, Wenger, Brindis (b0040) 2014; 64 Riley, Miller, Russell (b0110) 2017; 35 Aldous, Mark Richards, George (b0060) 2014; 177 Nieuwets, Poldervaart, Reitsma (b0105) 2016; 6 van Dongen, Ottervanger, Tolsma (b0115) 2019 Stopyra, Harper, Higgins (b0100) 2018; 33 Ishak, Ali, Fokkert (b0020) 2018; 7 Backus, Six, Kelder (b0030) 2013; 168 Ishak, Ali, Fokkert (b0015) 2015; 4 Thygesen, Alpert, Jaffe (b0045) 2012; 126 Tolsma, Van Dongen, Fokkert, Ottervanger, Van Der Sluis, Slingerland (b0050) 2017; 38 Rasmussen, Stengaard, Sørensen (b0075) 2017 Stengaard, Sørensen, Ladefoged (b0070) 2013; 112 Roffi, Patrono, Collet (b0035) 2016; 37 Chapman, Hesse, Andrews (b0090) 2018; 138 Pickering, Greenslade, Cullen (b0080) 2016; 102 van Dongen DN, Badings EA, Tolsma RT, et al. Pre-hospital versus Hospital Acquired HEART Score for Risk Classification of Suspected NSTE-ACS. [submitted for publication]. Parsonage, Mueller, Greenslade (b0085) 2016; 102 Poldervaart, Reitsma, Backus (b0095) 2017; 166 Jungbauer, Hupf, Giannitsis (b0010) 2017; 63 van Dongen, Tolsma, Fokkert (b0025) 2018 Mahler, Stopyra, Apple (b0055) 2017; 50 Ezekowitz, Welsh, Weiss (b0065) 2015; 4 Nieuwets (10.1016/j.ajem.2019.158448_b0105) 2016; 6 Jungbauer (10.1016/j.ajem.2019.158448_b0010) 2017; 63 Tolsma (10.1016/j.ajem.2019.158448_b0050) 2017; 38 Ishak (10.1016/j.ajem.2019.158448_b0020) 2018; 7 Mahler (10.1016/j.ajem.2019.158448_b0055) 2017; 50 Parsonage (10.1016/j.ajem.2019.158448_b0085) 2016; 102 Stengaard (10.1016/j.ajem.2019.158448_b0070) 2013; 112 Riley (10.1016/j.ajem.2019.158448_b0110) 2017; 35 Ezekowitz (10.1016/j.ajem.2019.158448_b0065) 2015; 4 Roffi (10.1016/j.ajem.2019.158448_b0035) 2016; 37 Poldervaart (10.1016/j.ajem.2019.158448_b0095) 2017; 166 van Dongen (10.1016/j.ajem.2019.158448_b0025) 2018 Mahler (10.1016/j.ajem.2019.158448_b0120) 2018; 138 Rasmussen (10.1016/j.ajem.2019.158448_b0075) 2017 van Dongen (10.1016/j.ajem.2019.158448_b0115) 2019 Amsterdam (10.1016/j.ajem.2019.158448_b0040) 2014; 64 10.1016/j.ajem.2019.158448_b0005 Pickering (10.1016/j.ajem.2019.158448_b0080) 2016; 102 Chapman (10.1016/j.ajem.2019.158448_b0090) 2018; 138 Ishak (10.1016/j.ajem.2019.158448_b0015) 2015; 4 Aldous (10.1016/j.ajem.2019.158448_b0060) 2014; 177 Stopyra (10.1016/j.ajem.2019.158448_b0100) 2018; 33 Backus (10.1016/j.ajem.2019.158448_b0030) 2013; 168 Thygesen (10.1016/j.ajem.2019.158448_b0045) 2012; 126 |
| References_xml | – reference: van Dongen DN, Badings EA, Tolsma RT, et al. Pre-hospital versus Hospital Acquired HEART Score for Risk Classification of Suspected NSTE-ACS. [submitted for publication]. – year: 2019 ident: b0115 article-title: In-hospital healthcare utilization, outcomes, and costs in pre-hospital-adjudicated low-risk chest-pain patients publication-title: Appl Health Econ Health Policy – volume: 166 start-page: 689 year: 2017 end-page: 697 ident: b0095 article-title: Effect of using the HEART score in patients with chest pain in the emergency department: a Stepped-wedge, cluster randomized trial publication-title: Ann Intern Med – year: 2017 ident: b0075 article-title: Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction publication-title: Eur Hear J Acute Cardiovasc Care – volume: 126 start-page: 2020 year: 2012 end-page: 2035 ident: b0045 article-title: Third universal definition of myocardial infarction publication-title: Circulation – volume: 112 start-page: 1361 year: 2013 end-page: 1366 ident: b0070 article-title: Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction publication-title: Am J Cardiol – volume: 7 start-page: 102 year: 2018 end-page: 110 ident: b0020 article-title: 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 publication-title: Eur Hear J Acute Cardiovasc Care – volume: 35 start-page: 77 year: 2017 end-page: 81 ident: b0110 article-title: Cost analysis of the History, ECG, age, risk factors, and initial troponin (HEART) pathway randomized control trial publication-title: Am J Emerg Med – volume: 168 start-page: 2153 year: 2013 end-page: 2158 ident: b0030 article-title: A prospective validation of the HEART score for chest pain patients at the emergency department publication-title: Int J Cardiol – volume: 138 start-page: 1654 year: 2018 end-page: 1665 ident: b0090 article-title: High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome publication-title: Circulation – volume: 33 start-page: 58 year: 2018 end-page: 62 ident: b0100 article-title: Prehospital modified HEART score predictive of 30-day adverse cardiac events publication-title: Prehosp Disaster Med – volume: 63 year: 2017 ident: b0010 article-title: Analytical and clinical validation of a point-of-care cardiac troponin T test with an improved detection limit publication-title: Clin Lab – volume: 4 year: 2015 ident: b0065 article-title: Providing rapid out of hospital acute cardiovascular treatment 4 (PROACT-4) publication-title: J Am Heart Assoc – volume: 38 start-page: 48 year: 2017 ident: b0050 article-title: 48 The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI publication-title: Eur Heart J – volume: 102 start-page: 1279 year: 2016 end-page: 1286 ident: b0085 article-title: Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests publication-title: Heart – volume: 50 start-page: 401 year: 2017 end-page: 407 ident: b0055 article-title: Use of the HEART Pathway with high sensitivity cardiac troponins: a secondary analysis publication-title: Clin Biochem – volume: 37 start-page: 267 year: 2016 end-page: 315 ident: b0035 article-title: 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation publication-title: Eur Heart J – volume: 102 start-page: 1270 year: 2016 end-page: 1278 ident: b0080 article-title: Validation of presentation and 3 h high-sensitivity troponin to rule-in and rule-out acute myocardial infarction publication-title: Heart – year: 2018 ident: b0025 article-title: Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: a prospective observational study publication-title: Eur Hear J Acute Cardiovasc Care – volume: 4 start-page: 129 year: 2015 end-page: 136 ident: b0015 article-title: Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway: rationale and design publication-title: Eur Hear J Acute Cardiovasc Care – volume: 138 start-page: 2456 year: 2018 end-page: 2468 ident: b0120 article-title: Safely identifying emergency department patients with acute chest pain for early discharge publication-title: Circulation – volume: 6 year: 2016 ident: b0105 article-title: Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis publication-title: BMJ Open – volume: 64 start-page: 2645 year: 2014 end-page: 2687 ident: b0040 article-title: 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: executive summary publication-title: J Am Coll Cardiol – volume: 177 start-page: 182 year: 2014 end-page: 186 ident: b0060 article-title: Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction publication-title: Int J Cardiol – volume: 6 year: 2016 ident: 10.1016/j.ajem.2019.158448_b0105 article-title: Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis publication-title: BMJ Open doi: 10.1136/bmjopen-2015-010694 – volume: 50 start-page: 401 year: 2017 ident: 10.1016/j.ajem.2019.158448_b0055 article-title: Use of the HEART Pathway with high sensitivity cardiac troponins: a secondary analysis publication-title: Clin Biochem doi: 10.1016/j.clinbiochem.2017.01.003 – volume: 102 start-page: 1270 year: 2016 ident: 10.1016/j.ajem.2019.158448_b0080 article-title: Validation of presentation and 3 h high-sensitivity troponin to rule-in and rule-out acute myocardial infarction publication-title: Heart doi: 10.1136/heartjnl-2015-308505 – volume: 102 start-page: 1279 year: 2016 ident: 10.1016/j.ajem.2019.158448_b0085 article-title: Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests publication-title: Heart doi: 10.1136/heartjnl-2016-309270 – volume: 35 start-page: 77 year: 2017 ident: 10.1016/j.ajem.2019.158448_b0110 article-title: Cost analysis of the History, ECG, age, risk factors, and initial troponin (HEART) pathway randomized control trial publication-title: Am J Emerg Med doi: 10.1016/j.ajem.2016.10.005 – volume: 64 start-page: 2645 year: 2014 ident: 10.1016/j.ajem.2019.158448_b0040 article-title: 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: executive summary publication-title: J Am Coll Cardiol doi: 10.1016/j.jacc.2014.09.016 – volume: 138 start-page: 2456 year: 2018 ident: 10.1016/j.ajem.2019.158448_b0120 article-title: Safely identifying emergency department patients with acute chest pain for early discharge publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.118.036528 – volume: 168 start-page: 2153 year: 2013 ident: 10.1016/j.ajem.2019.158448_b0030 article-title: A prospective validation of the HEART score for chest pain patients at the emergency department publication-title: Int J Cardiol doi: 10.1016/j.ijcard.2013.01.255 – volume: 126 start-page: 2020 year: 2012 ident: 10.1016/j.ajem.2019.158448_b0045 article-title: Third universal definition of myocardial infarction publication-title: Circulation doi: 10.1161/CIR.0b013e31826e1058 – year: 2018 ident: 10.1016/j.ajem.2019.158448_b0025 article-title: Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: a prospective observational study publication-title: Eur Hear J Acute Cardiovasc Care – volume: 112 start-page: 1361 year: 2013 ident: 10.1016/j.ajem.2019.158448_b0070 article-title: Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction publication-title: Am J Cardiol doi: 10.1016/j.amjcard.2013.06.026 – volume: 138 start-page: 1654 year: 2018 ident: 10.1016/j.ajem.2019.158448_b0090 article-title: High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.118.036426 – volume: 166 start-page: 689 year: 2017 ident: 10.1016/j.ajem.2019.158448_b0095 article-title: Effect of using the HEART score in patients with chest pain in the emergency department: a Stepped-wedge, cluster randomized trial publication-title: Ann Intern Med doi: 10.7326/M16-1600 – volume: 63 year: 2017 ident: 10.1016/j.ajem.2019.158448_b0010 article-title: Analytical and clinical validation of a point-of-care cardiac troponin T test with an improved detection limit publication-title: Clin Lab doi: 10.7754/Clin.Lab.2016.160814 – volume: 37 start-page: 267 year: 2016 ident: 10.1016/j.ajem.2019.158448_b0035 article-title: 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation publication-title: Eur Heart J doi: 10.1093/eurheartj/ehv320 – volume: 4 year: 2015 ident: 10.1016/j.ajem.2019.158448_b0065 article-title: Providing rapid out of hospital acute cardiovascular treatment 4 (PROACT-4) publication-title: J Am Heart Assoc doi: 10.1161/JAHA.115.002859 – volume: 33 start-page: 58 year: 2018 ident: 10.1016/j.ajem.2019.158448_b0100 article-title: Prehospital modified HEART score predictive of 30-day adverse cardiac events publication-title: Prehosp Disaster Med doi: 10.1017/S1049023X17007154 – volume: 38 start-page: 48 issue: ehx501 year: 2017 ident: 10.1016/j.ajem.2019.158448_b0050 article-title: 48 The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI publication-title: Eur Heart J – year: 2019 ident: 10.1016/j.ajem.2019.158448_b0115 article-title: In-hospital healthcare utilization, outcomes, and costs in pre-hospital-adjudicated low-risk chest-pain patients publication-title: Appl Health Econ Health Policy doi: 10.1007/s40258-019-00502-6 – ident: 10.1016/j.ajem.2019.158448_b0005 – volume: 4 start-page: 129 year: 2015 ident: 10.1016/j.ajem.2019.158448_b0015 article-title: Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway: rationale and design publication-title: Eur Hear J Acute Cardiovasc Care doi: 10.1177/2048872614549738 – volume: 7 start-page: 102 year: 2018 ident: 10.1016/j.ajem.2019.158448_b0020 article-title: 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 publication-title: Eur Hear J Acute Cardiovasc Care doi: 10.1177/2048872616687116 – year: 2017 ident: 10.1016/j.ajem.2019.158448_b0075 article-title: Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction publication-title: Eur Hear J Acute Cardiovasc Care – volume: 177 start-page: 182 year: 2014 ident: 10.1016/j.ajem.2019.158448_b0060 article-title: Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction publication-title: Int J Cardiol doi: 10.1016/j.ijcard.2014.09.026 |
| SSID | ssj0011454 |
| Score | 2.3764863 |
| Snippet | Pre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less sensitive than... IntroductionPre-hospital risk classification by the HEART score is performed with point of care troponin assessment. However, point of care troponin is less... |
| SourceID | proquest crossref elsevier |
| SourceType | Aggregation Database Enrichment Source Index Database Publisher |
| StartPage | 1616 |
| SubjectTerms | Accuracy Acute coronary syndromes Angina pectoris Calcium-binding protein Classification Electrocardiography Emergency medical care Heart Heart attacks Hospitals Ischemia Laboratories Patients Statistical analysis Troponin |
| SummonAdditionalLinks | – databaseName: Health & Medical Collection dbid: 7X7 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwhV1LS8QwEA4-QLyIT1xfRPAm1TZJH3uSRVYWQS8q7C00Lx9Iu267B4_-c2fadAWRFXprp4fOZOZL8818hJwpAxgiZzZIQqUDoWJUA8x5kGRpmoVQgHSODc5398noSdyO47H_4VZ5WmWXE5tEbUqN_8gvsZRkKOeYXE0-AlSNwtNVL6GxTFab0WUQz-l4vuECqN-ooEEUI8E-Tn3TTMvvyt8sdqJH_YsIijDq__xdmH6l6Kbu3GySDQ8Y6aD18BZZssU2WbvzR-I75Gug9Wya609aOoqcjhevBEJHQwCrtMI5lRQZ5FQjUkZqUOMNipT3ZzopX4sabZEDRpGkMasoDjGmFXLbMRvSGqUUiteCwgW3sTnTGnr_8DgMBtcPu-TpZvh4PQq8rkKgRcTqgMH3zyzLDaA_EYV9xhzgHhEzZ1ymnOHMpkY4p4XRWWKzlGutolSHLuSOJ4rvkZWiLOw-oZZpjcQT42wijLDKAIQI-4qHxvXzUPRI1H1Uqf3QcdS-eJcdu-xNoiMkOkK2juiR87nNpB25sfBp3vlKds2kkP4kVISFVvHcykONFkL8a3fUhYP0i72SP6HZI6fz27BM8ewlL2w5g2d4xAErwG75YPErDsk6wy19wzE8Iiv1dGaPAffU6qQJ7m921AJS priority: 102 providerName: ProQuest |
| Title | Accuracy of pre-hospital HEART score risk classification using point of care versus high sensitive troponin in suspected NSTE-ACS |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0735675719305972 https://dx.doi.org/10.1016/j.ajem.2019.158448 https://www.proquest.com/docview/2426801056 https://www.proquest.com/docview/2313362156 |
| Volume | 38 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3di9NAEF_OHogv4idWz2MF3yTX7EeyyWMtParlilzvsG9L9kt7SFqu6YMvgv-5M8mmoMgJQkggu0PCzu7Mb9nfzBDy1jjAEBX3SZ4am0iTYTXASiR5oVSRggOyFQY4Xyzy2bX8uMpWR2TSx8IgrTLa_s6mt9Y6vhnF0Rxt1-vREiZnBnBXAQQBjKDADh9zUebZgByPP8xni8NhApNtMTTsn6BAjJ3paF7VjceAdFaeMfDFWAbo7_7pD0vdup_zR-RhxI103P3aY3Lk6yfk_kU8GX9Kfo6t3d9W9jvdBIrUjq-xIAidTQGz0h2mq6RIJKcWATMyhFqlUGS-f6HbzbpuUBapYBS5GvsdxVzGdIcUdzSKtMGKCvW6pnBBM8ZoekcXy6tpMp4sn5Hr8-nVZJbE8gqJlYw3CQc1FJ5XDkCgZGnJeQD4IzMeXChMcIJ75WQIVjpb5L5QwlrDlE1DKoLIjXhOBvWm9i8I9dxa5J-44HPppDcOkERaGpG6UFapHBLWD6q2Mfc4lsD4pnuS2Y1GRWhUhO4UMSTvDjLbLvPGnb1Fryvdx5SCFdTgGO6Uyg5Sv826f8qd9NNBxzW_0wh2Ciw4mg_Jm0MzrFY8gqlqv9lDH8EEQAbYNL_8z0-_Ig84bvlbDuIJGTS3e_8acFFjTsm9sx8M7mqlTuMawOf88vMcnu-ni0-XvwBxExGj |
| linkProvider | Elsevier |
| linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1Lb9QwEB6VrQRcEE-xUMBIcEKBxHYee0BoKVttaXeF6FbqzY1f0AolS5MV6pE_xG9kJo9FQmg5VcotnkTy2DOf7W_8AbzQFjFEzl2QhNoEUsekBpiLIMnSNAsxAZmcCpxn82R6LD-exCdb8KuvhSFaZR8Tm0BtS0N75G8olWQk55i8W34PSDWKTld7CY12WBy4yx-4ZKve7n9A_77kfG-y2J0GnapAYGTE64Dj3zPHc4vYR0bhiHOPWV_G3FufaW8Fd6mV3htpTZa4LBXG6Cg1oQ-FF4kW-N1rsC2ponUA2-8n80-f1-cWkWx013DeEKU_TrsynZZRlp87qn2PRq8jTPukOPTvVPhXUmgy3d5tuNVBVDZux9Qd2HLFXbg-6w7h78HPsTGri9xcstIzYpF87bRH2HSC8JhVdDMmI846M4TNiYzU-J8Ryf4LW5ZnRU22xDpjRAtZVYyuTWYVsekp_rKaxBuKs4Lhg6-pHNRZNj9aTILx7tF9OL6SPn8Ag6Is3ENgjhtDVBfrXSKtdNoiaAlHWoTWj_JQDiHqO1WZ7ppzUtv4pno-27kiRyhyhGodMYRXa5tle8nHxtai95Xqy1cx4CrMQRut4rVVB25a0PJfu51-OKguvFTqz2QYwvP1awwMdNqTF65cYRsRCUQnuD5_tPkTz-DGdDE7VIf784PHcJPThkLDcNyBQX2xck8QddX6aTfUGZxe9ez6DZoNQds |
| linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1ba9RAFD7UCsUXsV5wtdYR9Elik5nJZR-kLO0uW2sXoS3s25i51RZJ1iaL9NG_5a_rObmsILI-FfYtOWHJuX2T-c58AG-1RQyRcxckoTaB1DGpAeYiSLI0zUJsQCanAeeTWTI9l5_m8XwDfvezMESr7GtiU6htaegb-R61kozkHJM939EivhxO9hc_AlKQop3WXk6jDZFjd_MTl2_Vx6ND9PU7zifjs4Np0CkMBEZGvA44_pPM8dwiDpJROOTcIwKQMffWZ9pbwV1qpfdGWpMlLkuFMTpKTehD4UWiBT73HtxPBaIqzKV0vlrs4TKjUWDDDCJyf5x2Azsttyy_cjQFHw0_RAgASHvo303xr_bQ9LzJI3jYgVU2aqNrGzZc8Ri2Trrt-Cfwa2TM8jo3N6z0jPgk3zoVEjYdI1BmFZ2RyYi9zgyhdKIlNZHAiG5_wRblZVGTLfHPGBFElhWjA5RZRbx6qsSsJhmH4rJg-MPLNBjqLJudno2D0cHpUzi_kzf-DDaLsnDPgTluDJFerHeJtNJpi_AlHGoRWj_MQzmAqH-pynQHnpPuxnfVM9uuFDlCkSNU64gBvF_ZLNrjPtbeLXpfqX6QFUuvwm601ipeWXUwp4Uv_7Xb6cNBdYWmUn_SYgBvVpexRNC-T164con3iEggTsGV-ov1j3gNW5hT6vPR7PglPOD0ZaGhOu7AZn29dK8QftV6t4lzBl_vOrFuAcxqRKI |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Accuracy+of+pre-hospital+HEART+score+risk+classification+using+point+of+care+versus+high+sensitive+troponin+in+suspected+NSTE-ACS&rft.jtitle=The+American+journal+of+emergency+medicine&rft.au=van+Dongen%2C+Dominique+N&rft.au=Fokkert%2C+Marion+J&rft.au=Tolsma%2C+Rudolf+T&rft.au=van+der+Sluis%2C+Aize&rft.date=2020-08-01&rft.issn=1532-8171&rft.eissn=1532-8171&rft.volume=38&rft.issue=8&rft.spage=1616&rft_id=info:doi/10.1016%2Fj.ajem.2019.158448&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0735-6757&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0735-6757&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0735-6757&client=summon |