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

G W A Aarts, K van der Wulp, C Camaro, G W A Aarts, K van der Wulp, C Camaro

Abstract

In the majority of patients with chest pain, an acute coronary syndrome (ACS) can be ruled out. However, early recognition of an ACS is required in order to start treatment as soon as possible and reduce risks associated with myocardial ischaemia. Because of the lack of pre-hospital protocols to rule out an ACS, patients with a suspected ACS are transported to the emergency department, where the HEART score can be used to estimate the risk of major adverse cardiac events (MACE). Patients with a low HEART score have a low risk of MACE. A point-of-care (POC) troponin measurement enables ambulance paramedics to calculate the HEART score in the pre-hospital setting. POC troponin measurement and HEART score assessment have several potential advantages, including early recognition of an ACS and identification of high-risk patients before hospital arrival. Moreover, pre-hospital rule-out of an ACS could prevent unnecessary emergency department visits. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin value to the general practitioner are currently being investigated in the ARTICA randomised trial. This point-of-view article demonstrates one of the potential advantages of early detection of an ACS.

Keywords: Acute coronary syndrome; HEART score; Non-ST-segment elevation; Point-of-care troponin; Randomised trial.

Conflict of interest statement

C. Camaro received a ZonMw grant for the ARTICA trial. G.W.A. Aarts and K. van der Wulp declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Design of the ARTICA trial. (ECG electrocardiogram, LBBB left bundle branch block, PM pacemaker, BMI body mass index, POC point-of-care)
Fig. 2
Fig. 2
Electrocardiogram in the ambulance
Fig. 3
Fig. 3
Electrocardiogram in the emergency department, 15 min after arrival
Fig. 4
Fig. 4
Coronary angiography. a Proximal occlusion of the right coronary artery. b After percutaneous coronary intervention

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Source: PubMed

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