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Pre-hospital point-of-care troponin measurement: a clinical example of its additional value

G W A Aarts1, K van der Wulp1, C Camaro2

  • 1Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|June 10, 2020
PubMed

Insights

Early detection of acute coronary syndrome (ACS) using point-of-care troponin and the HEART score in the pre-hospital setting can identify low-risk patients. This approach may reduce emergency department visits and enable timely treatment for high-risk individuals.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Testing

Background:

  • Acute coronary syndrome (ACS) requires prompt recognition to minimize myocardial ischemia risks.
  • Current pre-hospital protocols often lack ACS rule-out capabilities, leading to emergency department (ED) transport for suspected cases.
  • The HEART score is utilized in EDs to assess the risk of major adverse cardiac events (MACE).

Purpose of the Study:

  • To explore the potential advantages of pre-hospital point-of-care (POC) troponin measurement and HEART score assessment for early ACS detection.
  • To highlight the benefits of identifying high-risk patients and potentially ruling out ACS before hospital arrival.
  • To discuss the implications of pre-hospital ACS rule-out for reducing unnecessary ED visits.

Main Methods:

  • Utilizing point-of-care (POC) troponin measurements by ambulance paramedics.
  • Calculating the HEART score in the pre-hospital setting based on POC troponin results and clinical parameters.
  • Reviewing the potential impact of these pre-hospital assessments on patient management and healthcare resource utilization.

Main Results:

  • POC troponin measurement allows paramedics to calculate the HEART score pre-hospital.
  • This enables early identification of patients at low risk for MACE.
  • Potential for early recognition of ACS and identification of high-risk patients prior to ED arrival.

Conclusions:

  • Pre-hospital POC troponin and HEART score assessment offer significant advantages for early ACS detection.
  • This strategy can facilitate timely treatment initiation and potentially prevent unnecessary emergency department visits.
  • The ARTICA trial is investigating the safety and cost-effectiveness of referring low-risk patients to general practitioners.

Keywords:
Acute coronary syndromeHEART scoreNon-ST-segment elevationPoint-of-care troponinRandomised trial

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