High-Sensitivity Troponin I in Addition to Guideline-Based Care in EMS (TIGER)

June 27, 2025 updated by: Jakob Lederman, Karolinska Institutet

High-Sensitivity Troponin I in Addition to Guideline-Based Care in Emergency Medical Service - an Open Randomized Controlled Trial

The TIGER study is a study investigating the utlility of a point-of-care blood analyse of Troponin I to help identify patients with heart attacks in the prehospital emergency care. The study is conducted within the ambulance services of Region Stockholm and compares standard medical care with and without the addition of this quick test.

Chest pain is one of the most common reasons for ambulance dispatch, but currently only about one-third of heart attacks are detected before arriving at the hospital-mainly through ECG. The remaining two-thirds are not identified until after further testing at the emergency department. The TIGER study aims to improve early diagnosis by using a high-sensitivity, point-of-care Troponin I test already in the prehospital phase.

The study is a randomized controlled trial, where participants are randomly assigned to one of two groups. One group receives standard emergency care along with the rapid Troponin I test in the ambulance. The other group receives standard care without the test. The goal is to evaluate whether the use of Troponin I testing leads to faster and more accurate identification of heart attacks, ultimately improving patient outcomes.

In total, about 1,419 adult patients with chest pain or suspected heart attack will participate. The primary outcome being measured is the time from first medical contact to PCI (balloon angioplasty). Secondary outcomes include time spent in different parts of care, hospital length of stay, the occurrence of serious events (such as heart attack, stroke, or death), and the diagnostic accuracy of the test.

The study has been approved by the Swedish Ethical Review Authority and includes safety monitoring through an interim analysis after the first 150 patients. Test results from the Troponin I analysis are clearly marked as part of the research study and should be interpreted by the responsible physician alongside other clinical findings.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The TIGER study is a prospective, open-label, randomized controlled trial designed to evaluate the clinical utility of prehospital high-sensitivity Troponin I testing in patients presenting with chest pain or suspected myocardial infarction (MI). The study is conducted within the emergency medical services (EMS) in Stockholm, Sweden.

Participants are randomized in a 2:1 ratio to receive either standard guideline-based care alone or standard care plus point-of-care Troponin I testing using the Siemens Atellica® VTLi system. The Troponin result is available to EMS providers in real-time and is communicated to the receiving hospital as part of the routine prehospital handover.

The study aims to assess whether the addition of early biomarker data can improve triage, reduce time to treatment (FMC-to-balloon time), and optimize the use of healthcare resources. An interim analysis will be conducted after 150 patients have been enrolled. The study has been approved by the Swedish Ethical Review Authority.

Study Type

Interventional

Enrollment (Estimated)

1419

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Sweden
    • Årsta
      • Stockholm, Årsta, Sweden, 12040
        • Recruiting
        • Ambulance care in greater Stockholm Ltd. (AISAB)
        • Contact:
        • Principal Investigator:
          • Jakob Lederman, Phd
        • Sub-Investigator:
          • Veronica Vicente, Ass. professor
        • Sub-Investigator:
          • Sebastian Bjöhle, Doctoral student

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Chestpain / discomfort and/or
  • Clinical suspicion of myocardial infarction by the prehospital personeel

Exclusion Criteria:

  • Patients suffering from a trauma and conveyed to the trauma level 1 hospital.
  • Missing valid social security number
  • Not beeing able to give informed consent
  • Not a primary assignment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention
Getting a point-of-care Troponin I analysed, in addition to care according to medical guidelines in EMS
Diagnostic test: high sensitivity Troponin I
Study participants in the intervention group will have the high-sensitivity Troponin I blood test analyzed during emergency medical service (EMS) care using the point-of-care Siemens Atellica® VTLi system. The test result will be documented in the EMS electronic medical record (FRAPP), transmitted along with the ECG, and communicated verbally to the receiving hospital during handover.
No Intervention: Control
Getting care according to medical guidelines in EMS

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time from First Medical Contact to Vascular Access (FMC-to-Access Time)
Time Frame: From time of first medical contact by EMS to time of vascular access during index PCI procedure, assessed during index hospitalization (typically within 72 hours)
Time in minutes from the initial contact with emergency medical services (EMS) to vascular access (arterial puncture) for percutaneous coronary intervention (PCI), representing the time to initiation of the invasive procedure.
From time of first medical contact by EMS to time of vascular access during index PCI procedure, assessed during index hospitalization (typically within 72 hours)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time from First Medical Contact to Initial ECG (FMC-to-ECG Time)
Time Frame: From time of initial patient contact by EMS personnel to time of first ECG, assessed during prehospital phase (typically within 1 hour)
Time in minutes from the first contact with emergency medical services (EMS) personnel-defined as the moment EMS arrives at the patient-to completion of the first 12-lead ECG.
From time of initial patient contact by EMS personnel to time of first ECG, assessed during prehospital phase (typically within 1 hour)
Time from First Medical Contact to Emergency Department Admission (FMC-to-ED Admission Time)
Time Frame: From time of first medical contact to ED admission, assessed on the day of presentation (typically within 4 hours)
Time in minutes from first EMS contact to arrival and registration at the emergency department.
From time of first medical contact to ED admission, assessed on the day of presentation (typically within 4 hours)
Emergency Department Length of Stay
Time Frame: From time of ED admission to ED discharge, assessed during index visit (typically within 24 hours)
Duration in minutes from emergency department registration to transfer or discharge from the ED.
From time of ED admission to ED discharge, assessed during index visit (typically within 24 hours)
Total Hospital Length of Stay
Time Frame: From ED admission to hospital discharge, assessed during index hospitalization (up to 14 days)
Duration in minutes from emergency department admission to hospital discharge (from acute care facility).
From ED admission to hospital discharge, assessed during index hospitalization (up to 14 days)
Major Adverse Cardiovascular Events (MACE)
Time Frame: Assessed at 72 hours and at 30 days from the time of first medical contact, defined as the arrival of emergency medical services (EMS)
Composite outcome including the occurrence of any of the following within the specified time frames: myocardial infarction, angina pectoris, all-cause mortality, stroke, or heart failure with reduced ejection fraction (HFrEF).
Assessed at 72 hours and at 30 days from the time of first medical contact, defined as the arrival of emergency medical services (EMS)
Number of Interventions Performed During Acute Care Episode
Time Frame: From the time of first medical contact-defined as the arrival of EMS personnel at the patient's side-through hospital discharge, assessed during the full acute care episode (up to 14 days)
Total number of interventions performed per patient from first medical contact through hospital discharge. Interventions may include prehospital treatments (e.g., defibrillation, medication administration) and in-hospital procedures such as diagnostic angiography, percutaneous coronary intervention (PCI), temporary pacing, or surgery.
From the time of first medical contact-defined as the arrival of EMS personnel at the patient's side-through hospital discharge, assessed during the full acute care episode (up to 14 days)
Proportion of participants assigned to in-hospital care
Time Frame: From admission to discharge, during index hospitalization (up to 14 days)

Proportion of participants assigned to each predefined category of in-hospital care, based on the most resource-intensive setting they were treated in during the index hospitalization. The categories include:

  • Emergency Department (ED) only
  • Direct to Percutaneous Coronary Intervention (PCI)
  • Cardiac Intensive Care Unit (CICU)
  • Intermediate Care Unit
  • Other Cardiac Unit
  • General Care Unit
  • External Care Institution (e.g., step-down or rehabilitation facility)

Unit of Measure: Percentage of participants (%)
From admission to discharge, during index hospitalization (up to 14 days)
Clinical Utility: Sensitivity, Specificity, Negative Predictive Value (NPV), and Positive Predictive Value (PPV).
Time Frame: From the time of EMS assessment (first medical contact) to confirmation of final diagnosis at hospital discharge (typically within 7-14 days)
Diagnostic performance of prehospital assessment for identifying patients with Myocardial infarction. Includes calculation of sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV), using confirmed diagnosis (ICD-code) at discharge as reference standard.
From the time of EMS assessment (first medical contact) to confirmation of final diagnosis at hospital discharge (typically within 7-14 days)
Incidence of Other Time-Critical Medical Conditions
Time Frame: Assessed up to 30 days from the time of first medical contact by emergency medical services (EMS)
Number of participants diagnosed with other time-critical medical conditions within 30 days of first medical contact. These may include but are not limited to: stroke, sepsis, aortic dissection, pulmonary embolism, or major trauma.
Assessed up to 30 days from the time of first medical contact by emergency medical services (EMS)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Karolinska Institutet

Collaborators

Ambulance care in Greater Stockholm Ltd (AISAB), Region Stockholm

Investigators

  • Principal Investigator: Jakob Lederman, PhD, Karolinska Institute, Department of Clinical Science and Education
  • Study Chair: Veronica Vicente, Docent, Karolinska Institute, Department of Clinical Science and Education

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 25, 2025

Primary Completion (Estimated)

June 30, 2026

Study Completion (Estimated)

December 30, 2026

Study Registration Dates

First Submitted

May 16, 2025

First Submitted That Met QC Criteria

June 4, 2025

First Posted (Actual)

June 6, 2025

Study Record Updates

Last Update Posted (Actual)

July 2, 2025

Last Update Submitted That Met QC Criteria

June 27, 2025

Last Verified

June 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2023-07919-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

IPD will not be shared because consent for data sharing was not obtained from participants and data sharing is not feasible due to ethical restrictions

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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