chest pain, myocardial infarction, non-ST segment elevation acute coronary syndrome, troponin
Conditions
Interventions
Pre-hospital triage with management by the General practitioner versus pre-hospital triage with standard referral to the hospital
Sponsors
Radboud university medical center, Department of Cardiology
Eligibility
Inclusion criteria
Inclusion criteria: - Age at least 18 years; male ánd female - All out-of-hospital patients with chest pain or symptoms suggestive of ACS initially visited by an ambulance with an indication for transfer to a hospital to evaluate and rule out ACS - Symptom duration for at least two hours - Modified HEAR(T) score less or equal than 3 - A point of care troponin below the upper reference limit (for patients stratified to prehospital management by the general practitioner) - The patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent.
Exclusion criteria
Exclusion criteria: - Electrocardiographic ST-segment elevation - Patients presenting an obvious non-cardiac cause for the chest complaints who need evaluation at an emergency department, e.g. trauma, pneumothorax, sepsis, etc. - Patients in comatose state, defined as an EMV 100 and peripheral oxygen saturation <90% (without oxygen administration) - Patients presenting with syncope - Patients presenting with signs of heart failure - Patients presenting with heart rhythm disorders and second or third degree atrioventricular block - Patients with known end-stage renal disease (dialysis and/or MDRD < 30 ml/min) - Patients without a pre-hospital 12-lead ECG performed or available - Patients suspicious of aortic dissection or pulmonary embolism - Patients with confirmed AMI, PCI or CABG <30 days prior to inclusion - Communication issues with patient/language barrier - Decision of a present general practitioner to evaluate the patient at ER - Decision of the consultant cardiologist to evaluate patient at the ER irrespective of HEART score - Any significant medical or mental condition, which in the Investigator¡¯s opinion may interfere with the patient¡¯s optimal participation in the study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary endpoint consists of a significant reduction in health care costs at 30 days by a decrease in health care resources and use of ambulance | — |
Secondary
| Measure | Time frame |
|---|---|
| The secondary endpoint will determine the safety at one, six months and 12 months in major adverse cardiac events | — |
Contacts
Public ContactCyril Camaro
Department of Cardiology, Radboudumc, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
Outcome results
None listed