Evidence map›Paper›PMID 26627881›Full record

Trial reportJournal of the American Heart Association2015

Providing Rapid Out of Hospital Acute Cardiovascular Treatment 4 (PROACT-4).

Justin A Ezekowitz, Robert C Welsh, Dale Weiss, Michael Chan, William Keeble, Fadi Khadour, Sanjay Sharma, Wayne Tymchak, Sunil Sookram, Neil Brass and 4 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01634425 (Providing Rapid Out of Hospital Acute Cardiovascular Treatment), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01634425 phase4completednot on this map

Providing Rapid Out of Hospital Acute Cardiovascular Treatment (PROACT) Novel Proximal Pathways for Non ST Elevation Myocardial Infarction

TypeinterventionalSponsorUniversity of AlbertaRan2011 to 2015Enrolled601ConditionsNSTEMIArmsAlere Triage Meter Pro
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Point-of-care tests in the emergency medical services: a scoping review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025
    Article
  4. How Close Are We to Patient-Side Troponin Testing?Journal of clinical medicine · 2024
    Review
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 9 institutions in 2 countries.

Justin A EzekowitzCanadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada (J.A.E., R.C.W., Y.Z., P.W.A.) Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (J.A.E., R.C.W., W.T.).
Robert C WelshCanadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada (J.A.E., R.C.W., Y.Z., P.W.A.) Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (J.A.E., R.C.W., W.T.).
Dale WeissAlberta Health Services, Edmonton, Alberta, Canada (D.W., D.K.).
Michael ChanRoyal Alexandra Hospital, Edmonton, Alberta, Canada (M.C., N.B.).
William KeebleMisericordia Hospital, Edmonton, Alberta, Canada (W.K.).
Fadi KhadourSturgeon Community Hospital & Health Center, Edmonton, Alberta, Canada (F.K.).
Sanjay SharmaGrey Nuns Community Hospital, Edmonton, Alberta, Canada (S.S.).
Wayne TymchakMazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (J.A.E., R.C.W., W.T.).
Sunil SookramUniversity of Alberta Hospital, Edmonton, Alberta, Canada (S.S.).
Neil BrassRoyal Alexandra Hospital, Edmonton, Alberta, Canada (M.C., N.B.).
Darren KnappAlberta Health Services, Edmonton, Alberta, Canada (D.W., D.K.).
Thomas L KoshyAlere Inc, San Diego, CA (T.L.K.).
Yinggan ZhengCanadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada (J.A.E., R.C.W., Y.Z., P.W.A.).
Paul W ArmstrongCanadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada (J.A.E., R.C.W., Y.Z., P.W.A.).
Canadian VIGOUR Centre · CAAlberta Health Services · CARoyal Alexandra Hospital · CAAlere (United States) · USGrey Nuns Community Hospital · CAMisericordia Community Hospital · CASturgeon Community Hospital · CAUniversity of Alberta · CAUniversity of Alberta Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhether prehospital point-of-care (POC) troponin further accelerates the time to diagnosis in patients with chest pain (CP) is unknown. We conducted a randomized trial of POC-Troponin testing in the ambulance. METHODS AND

resultsPatients with chest pain presenting by ambulance were randomized to usual care (UC) or POC-Troponin; ST-elevation myocardial infarction patients or those with noncardiovascular symptoms were excluded. Pre-hospital high-sensitivity troponin was analyzed on a POC device and available to the paramedic and emergency department (ED) staff. The final diagnosis was centrally adjudicated. The primary endpoint was time from first medical contact to discharge from ED or admission to hospital. We randomized 601 patients in 19 months; 296 to UC and 305 to POC-Troponin. After ambulance arrival, the first troponin was available in 38 minutes in POC-Troponin and 139 minutes in UC. In POC-Troponin, the troponin was >0.01 ng/mL in 17.4% and >0.03 ng/mL in 9.8%. Patients spent a median of 9.0 hours from first medical contact to final disposition, and 165 (27.4%) were admitted to the hospital. The primary endpoint was shorter in patients randomized to POC-Troponin (median 8.8 hours [6.2-10.8] compared to UC (median 9.1 hours [6.7-11.2]; P=0.05). There was no difference in the secondary endpoint of repeat ED visits, hospitalizations, or death in the next 30 days.

conclusionsIn this broad population of patients with CP, ambulance POC-Troponin accelerated the time to final disposition. Enhanced and more cost-effective early ED discharge of the majority of patients with CP calling 911 is an unrealized opportunity. CLINICAL

trial registrationURL: https://www.ClinicalTrials.gov/. Unique identifier: NCT01634425.

Indexed as

Point-of-Care SystemsAgedAmbulancesCardiovascular DiseasesChest PainEmergency Medical ServicesFemaleHumansMaleMiddle AgedMyocardial InfarctionPredictive Value of TestsSensitivity and SpecificityTime FactorsTroponin ITroponin Iacute coronary syndromesambulancechest painclinical trialtroponin

Identifiers

PMID26627881
PMCPMC4845257
OpenAlexW2188915530

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.