Coronary disease & ACSMeta-analysis
Prehospital risk stratification in suspected non-ST-segment elevation acute coronary syndrome with point-of-care troponin: an individual patient data meta-analysis
- systematic review and individual patient data meta-analysis
- prospective studies
Authors' conclusion
In well-trained EMS systems, where prompt and accurate follow-up of low-risk patients is possible, HEART-derived CRS effectively identify patients with a very low risk of 30-day mortality and MACE. However, implementation in other healthcare systems requires additional validation, given the variations in healthcare structure, risk stratification processes and follow-up capabilities.
Study context
- Population
- Emergency Medical Services patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS), risk-stratified with clinical risk scores (CRS) or point-of-care (POC)-troponin in the prehospital settingpatients in 6 included studies (of 1526 articles screened)
- Participants
- 5.239 patients
- Comparison
- Low-risk stratification by CRS or POC-troponin measurement, assessed by sensitivity and negative predictive value (NPV) for three endpoints within 30 days
- Outcome
- Safety of low-risk stratification (sensitivity and NPV) for all-cause mortality; mortality and/or acute myocardial infarction (AMI); major adverse cardiac events (MACE)
- Follow-up
- Within 30 days
Pooled result
As reported in the abstract
| Group | All-cause mortality sensitivity | All-cause mortality NPV | Mortality and/or acute myocardial infarction (AMI) sensitivity | Mortality and/or AMI NPV | Major adverse cardiac events (MACE) sensitivity | MACE NPV |
|---|---|---|---|---|---|---|
| Low-risk CRS | 93.2% (83.5-98.1) | 99.8% (99.5-99.9) | 91.8% (83.0-96.2) | 97.3% (89.9-99.3) | 92.8% (88.7-95.5) | 97.2% (92.1-99.0) |
Further pooled results
Effect of lowering the CRS cut-off value for identifying low-risk patients
- Increased sensitivity and NPV but decreased the proportion of patients classified as low risk
Original publication
Prehospital risk stratification in suspected non-ST-segment elevation acute coronary syndrome with point-of-care troponin: an individual patient data meta-analysis. Heart. Published 2 January 2026. doi:10.1136/heartjnl-2025-326922
Summarised from the published abstract; every number is checked against it