Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score
BACKGROUND: The first study of the FamouS Triage project investigates the feasibility of ruling out a myocardial infarction in pre-hospital chest pain patients without electrocardiographic ST-segment elevation by using the modified HEART score at the patient's home, incorporating only a single highly sensitive troponin T measurement.METHODS: A venous blood sample was drawn in the ambulance from 1127 consecutive chest pain patients for measurement of the pre-hospital highly sensitive troponin T levels, in order to establish a pre-hospital HEART score (i.e. the modified HEART score) and evaluate the possibility of triage at the patient's home. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) i.e. acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or death within 30 days after initial presentation.RESULTS: Two hundred and six patients (18%) developed a MACE during 30 days of follow-up. Thirty-six per cent of the patients ( n=403) had a low modified HEART score (0-3 points) and none of them developed a MACE during follow-up. Forty-four per cent of the patients ( n=494) had an intermediate modified HEART score (4-6 points) and 18% of them developed a MACE. Twenty per cent of the patients ( n=230) had a high modified HEART score (7-10 points) of which 52% developed a MACE during follow-up.CONCLUSION: It seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score.TRIAL ID: NTR4205. Dutch Trial Register [ http://www.trialregister.nl ]: trial number 4205.
|Keywords||acute myocardial infarction, chest pain, highly sensitive troponin, modified HEART score, non-ST-segment elevation acute coronary syndrome, Pre-hospital triage|
|Persistent URL||dx.doi.org/10.1177/2048872616687116, hdl.handle.net/1765/114677|
|Journal||European Heart Journal: Acute Cardiovascular Care|
Ishak, M. (Maycel), Ali, D. (Danish), Fokkert, M.J. (Marion J.), Slingerland, R.J. (Robbert J.), Tolsma, R.T. (Rudolf T.), Badings, E. (Erik), … van 't Hof, A.W. (Arnoud Wj). (2018). Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score. European Heart Journal: Acute Cardiovascular Care, 7(2), 102–110. doi:10.1177/2048872616687116