Randomised controlled trial
Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial
- Randomised controlled trial
- investigator-initiated
- 5 ambulance regions in the Netherlands
Authors' conclusion
Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of MACE was low in both strategies.
Study context
- Population
- Suspected NSTE-ACS patients with HEAR score ≤3 (low risk), ambulance care
- Participants
- 863 patients
- Comparison
- Pre-hospital rule-out with point-of-care (POC) troponin vs direct transfer to the emergency department (ED)
- Pre-hospital strategyn = 434
- ED strategyn = 429reference
- Primary endpoint
- Healthcare costs
- Follow-up
- 30 days
Primary result
As reported in the abstract
Mean difference
611 €
95% CI 353–869
P < 0.001
By group
Pre-hospital strategy
€1349
± €2051
ED strategy
€1960
± €1808
Pre-hospital strategy vs ED strategy
mean difference 611 € (95% CI 353–869); P < 0.001
Safety
MACE (ACS, unplanned revascularization or all-cause death), total population · 30 days · comparable · secondary outcome
P = 0.89
| Outcome | Pre-hospital strategy | ED strategy | risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| MACE, ruled-out ACS population · 30 days | 0.5% | 1.0% | −0.5% (−1.6%-0.7%) | P = 0.41 | |
| −2−101Difference (linear scale) |
Original publication
Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial. Eur Heart J. Published 9 February 2023. doi:10.1093/eurheartj/ehad056
Summarised from the published abstract; every number is checked against it