BACKGROUND: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). METHODS: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. RESULTS: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group (p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group (p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk (p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). CONCLUSIONS: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.
BACKGROUND: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). METHODS: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. RESULTS: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group (p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group (p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk (p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). CONCLUSIONS: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.
Authors: Goaris W A Aarts; Cyril Camaro; Robert-Jan van Geuns; Etienne Cramer; Roland R J van Kimmenade; P Damman; Pierre M van Grunsven; Eddy Adang; Paul Giesen; Martijn Rutten; Olaf Ouwendijk; Marc E R Gomes; Niels van Royen Journal: BMJ Open Date: 2020-02-17 Impact factor: 2.692
Authors: Tonje R Johannessen; Odd Martin Vallersnes; Sigrun Halvorsen; Anne Cecilie K Larstorp; Ibrahimu Mdala; Dan Atar Journal: Open Heart Date: 2020-07
Authors: Enrico de Koning; Tom E Biersteker; Saskia Beeres; Jan Bosch; Barbra E Backus; Charles Jhj Kirchhof; Reza Alizadeh Dehnavi; Helen Am Silvius; Martin Schalij; Mark J Boogers Journal: BMJ Open Date: 2021-02-12 Impact factor: 2.692
Authors: Rudolf T Tolsma; Marion J Fokkert; Dominique N van Dongen; Erik A Badings; Aize van der Sluis; Robbert J Slingerland; Esther van 't Riet; Jan Paul Ottervanger; Arnoud W J van 't Hof Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-02-08
Authors: Jesse P A Demandt; Jo M Zelis; Arjan Koks; Geert H J M Smits; Pim van der Harst; Pim A L Tonino; Lukas R C Dekker; Marcel van Het Veer; Pieter-Jan Vlaar Journal: BMJ Open Date: 2022-04-05 Impact factor: 2.692
Authors: Tonje R Johannessen; Dan Atar; Odd Martin Vallersnes; Anne Cecilie K Larstorp; Ibrahimu Mdala; Sigrun Halvorsen Journal: BMJ Open Date: 2021-02-24 Impact factor: 2.692
Authors: Charles Richard Knoery; Janet Heaton; Rob Polson; Raymond Bond; Aleeha Iftikhar; Khaled Rjoob; Victoria McGilligan; Aaron Peace; Stephen James Leslie Journal: Crit Pathw Cardiol Date: 2020-09