ARTICA RCT primary outcome
BACKGROUND: Patients 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 e...
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ftdansls:doi:10.17026/dans-xd2-3zpg 2024-09-15T17:55:04+00:00 ARTICA RCT primary outcome C Camaro G.W.A. Aarts (Radboudumc Nijmegen) NIELS van Royen (Radboudumc) 2019-03-01 https://doi.org/10.17026/dans-xd2-3zpg English eng DANS Data Station Life Sciences https://doi.org/10.17026/dans-xd2-3zpg Medicine Health and Life Sciences Point-of-care troponin Risk stratification Acute coronary syndrome Pre-hospital triage HEART score 2019 ftdansls https://doi.org/10.17026/dans-xd2-3zpg 2024-07-26T14:07:07Z BACKGROUND: Patients 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 RESULTS: This 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. CONCLUSION: Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of major adverse cardiac events was low in both strategies Date Submitted: 2023-11-02 Other/Unknown Material artica DANS Data Station Life Sciences (Data Archiving and Networked Services) |
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DANS Data Station Life Sciences (Data Archiving and Networked Services) |
op_collection_id |
ftdansls |
language |
English |
topic |
Medicine Health and Life Sciences Point-of-care troponin Risk stratification Acute coronary syndrome Pre-hospital triage HEART score |
spellingShingle |
Medicine Health and Life Sciences Point-of-care troponin Risk stratification Acute coronary syndrome Pre-hospital triage HEART score C Camaro ARTICA RCT primary outcome |
topic_facet |
Medicine Health and Life Sciences Point-of-care troponin Risk stratification Acute coronary syndrome Pre-hospital triage HEART score |
description |
BACKGROUND: Patients 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 RESULTS: This 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. CONCLUSION: Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of major adverse cardiac events was low in both strategies Date Submitted: 2023-11-02 |
author2 |
G.W.A. Aarts (Radboudumc Nijmegen) NIELS van Royen (Radboudumc) |
author |
C Camaro |
author_facet |
C Camaro |
author_sort |
C Camaro |
title |
ARTICA RCT primary outcome |
title_short |
ARTICA RCT primary outcome |
title_full |
ARTICA RCT primary outcome |
title_fullStr |
ARTICA RCT primary outcome |
title_full_unstemmed |
ARTICA RCT primary outcome |
title_sort |
artica rct primary outcome |
publisher |
DANS Data Station Life Sciences |
publishDate |
2019 |
url |
https://doi.org/10.17026/dans-xd2-3zpg |
genre |
artica |
genre_facet |
artica |
op_relation |
https://doi.org/10.17026/dans-xd2-3zpg |
op_doi |
https://doi.org/10.17026/dans-xd2-3zpg |
_version_ |
1810431396353671168 |