Trial reportEuropean heart journal2023
Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial.
Trial report in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 30 papers.
What it found
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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.
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.
Acute Rule Out of Non ST-segment Elevation Acute Coronary Syndrome in the (Pre)Hospital Setting by HEART Score Assessment and a Single Point-of-care Troponin
Individual Patient Data Meta-analysis on Prehospital Risk Assessment in Patients Suspected of Non-ST-segment Elevation Acute Coronary Syndrome
Prehospital Point-of-Care High-Sensitivity Troponin I for Rule-Out of Acute Myocardial Infarction in Suspected Non-ST-Segment Elevation Acute Coronary Syndrome: A Pilot Study
Who cites it
30 citing papers in PubMed, 60 citations in OpenAlex.
- Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial.European heart journal. Quality of care & clinical outcomes · 2024Trial
- Comparison of Troponin in a Prehospital Blood Sample and Risk Scores.Diagnostics (Basel, Switzerland) · 2026Article
- Recruitment capacity and operational barriers to prehospital cardiac electrical biomarker acquisition: an ambulance-based pilot study.BMC cardiovascular disorders · 2026Observational
- Large language models for acute coronary syndrome triage at first medical contact in emergency departments.NPJ digital medicine · 2026Article
- Point-of-care diagnostics are central to acute medicine delivery.Future healthcare journal · 2026Article
- Advances in Diagnosis and Therapeutic Guidance for Acute Coronary Syndrome: A Narrative of A Precision Medicine Approach.Reviews in cardiovascular medicine · 2026Review
- New pathways with high-sensitivity cardiac troponin testing at the point of care in the ambulance and primary care.European heart journal. Acute cardiovascular care · 2026Article
- Agreement between ambulance paramedics and physicians on the (pre)hospital identification of low-risk chest pain patients.European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2026Article
- Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Pre-Hospital Artificial Intelligence-Guided, Focused Echocardiography in Patients with Acute Chest Pain for Diagnosis of Acute Coronary Syndrome.Journal of clinical medicine · 2025Article
- Cardiac troponin at the point of care in acute and chronic coronary syndromes.Diabetes, obesity & metabolism · 2025Review
- Validation for the Diagnostic Use of the HEART Score in Patients With Acute Chest Pain in Japan.Circulation reports · 2025Article
- Towards prehospital risk stratification using deep learning for ECG interpretation in suspected acute coronary syndrome.BMJ health & care informatics · 2025Article
- Point-of-care tests in the emergency medical services: a scoping review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Analytical and Clinical Performance of High-Sensitivity Cardiac Troponin Point-of-Care Assays as an Aid in the Diagnosis of Myocardial Infarction: A Narrative Review.Emergency medicine international · 2025Review
- Diagnostic Value of Long Non-Coding RNA NORAD in Acute Coronary Syndrome: A Diagnostic Biomarker Study.Journal of inflammation research · 2025Article
- Article
- How Close Are We to Patient-Side Troponin Testing?Journal of clinical medicine · 2024Review
- [Preclinical loading in patients with acute chest pain and acute coronary syndrome - PRELOAD survey].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Article
- Diagnostic Performance of Point-of-Care High-Sensitivity Troponin in the Exclusion of Non-ST-Elevation Myocardial Infarction in the Emergency Department.Journal of personalized medicine · 2024Article
Corrections and comments
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Authors and funding
18 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsPatients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are routinely transferred to the emergency department (ED). A clinical risk score with point-of-care (POC) troponin measurement might enable ambulance paramedics to identify low-risk patients in whom ED evaluation is unnecessary. The aim was to assess safety and healthcare costs of a pre-hospital rule-out strategy using a POC troponin measurement in low-risk suspected NSTE-ACS patients. METHODS AND
resultsThis investigator-initiated, randomized clinical trial was conducted in five ambulance regions in the Netherlands. Suspected NSTE-ACS patients with HEAR (History, ECG, Age, Risk factors) score ≤3 were randomized to pre-hospital rule-out with POC troponin measurement or direct transfer to the ED. The sample size calculation was based on the primary outcome of 30-day healthcare costs. Secondary outcome was safety, defined as 30-day major adverse cardiac events (MACE), consisting of ACS, unplanned revascularization or all-cause death. : A total of 863 participants were randomized. Healthcare costs were significantly lower in the pre-hospital strategy (€1349 ± €2051 vs. €1960 ± €1808) with a mean difference of €611 [95% confidence interval (CI): 353-869; P < 0.001]. In the total population, MACE were comparable between groups [3.9% (17/434) in pre-hospital strategy vs. 3.7% (16/429) in ED strategy; P = 0.89]. In the ruled-out ACS population, MACE were very low [0.5% (2/419) vs. 1.0% (4/417)], with a risk difference of -0.5% (95% CI -1.6%-0.7%; P = 0.41) in favour of the pre-hospital strategy.
conclusionPre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of MACE was low in both strategies.
trial registrationClinicaltrials.gov identifier NCT05466591 and International Clinical Trials Registry Platform id NTR 7346.
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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.