Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study
Dominique N van Dongen1, Rudolf T Tolsma2, Marion J Fokkert3
1Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
Insights
Pre-hospital HEART score accurately identifies low-risk patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS), minimizing major adverse cardiac events (MACE). This allows for better risk stratification and potential avoidance of unnecessary hospitalizations for low-risk individuals.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Risk Assessment
Background:
- Pre-hospital risk stratification for non-ST-elevation acute coronary syndrome (NSTE-ACS) using the HEART score has not been previously evaluated.
- Accurate early identification of NSTE-ACS is crucial for timely and appropriate patient management.
Purpose of the Study:
- To assess the accuracy of the pre-hospital HEART score in stratifying patients with suspected NSTE-ACS.
- To determine the score's ability to predict major adverse cardiac events (MACE) in this patient population.
Main Methods:
- Prospective observational study involving 700 patients with suspected NSTE-ACS.
- Ambulance paramedics performed risk stratification using the HEART score; a score of 3 or less indicated low risk.
- Primary endpoint was MACE within 45 days; secondary endpoints included myocardial infarction and death.
Main Results:
- 172 patients (24.6%) were classified as low risk, and 528 (75.4%) as intermediate to high risk.
- MACE occurred in 2.9% of the low-risk group versus 21.0% of the intermediate to high-risk group (p<0.001).
- No deaths were recorded in the low-risk group, with only 1.2% experiencing acute myocardial infarction.
Conclusions:
- Pre-hospital risk stratification using the HEART score, including troponin measurement, accurately differentiates low-risk from intermediate-to-high-risk patients with suspected NSTE-ACS.
- Future research should explore avoiding hospital transport for low-risk patients and immediate transfer for high-risk patients to facilities with early coronary angiography.
Background:
Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE).
Methods:
This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death.
Results:
A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group (p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group (p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk (p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%).
Conclusions:
In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
00:59Hospitals-II
Nurses that work in...