Maycel Ishak1, Danish Ali2, Marion J Fokkert3, Robbert J Slingerland3, Rudolf T Tolsma4, Erik Badings5, Aize van der Sluis5, Fred van Eenennaam6,7, Arend Mosterd8, Jurriën M Ten Berg9, Arnoud Wj van 't Hof1. 1. 1 Department of Cardiology, Isala Hospital, The Netherlands. 2. 2 Department of Cardiology, University Hospital Coventry, UK. 3. 3 Department of Clinical Chemistry, Isala Hospital, The Netherlands. 4. 4 Regional Ambulance Service IJsselland, Zwolle, The Netherlands. 5. 5 Department of Cardiology, Deventer Ziekenhuis, The Netherlands. 6. 6 The Decision Group, Amsterdam, The Netherlands. 7. 7 Erasmus School of Accounting & Assurance, Erasmus University, The Netherlands. 8. 8 Department of Cardiology, Meander Medical Centre, The Netherlands. 9. 9 Department of Cardiology, St Antonius Hospital, The Netherlands.
Abstract
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.
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.
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