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: rationale and design of the ARTICA randomised trial

• Published in: BMJ Open
• Main Authors: Roland R J van Kimmenade, Goaris W A Aarts, Etienne Cramer, P Damman, Pierre M van Grunsven, Eddy Adang, Paul Giesen, Martijn Rutten, Olaf Ouwendijk, Marc E R Gomes
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ Publishing Group 2020
• Subjects: Medicine; R; artica
• Online Access: https://doi.org/10.1136/bmjopen-2019-034403; https://doaj.org/article/9f50e28b4b2d4086aeebaad6c8ddf9d8

IntroductionBecause of the lack of prehospital protocols to rule out a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), patients with chest pain are often transferred to the emergency department (ED) for thorough evaluation. However, in low-risk patients, an ACS is rarely found, resulting in unnecessary healthcare consumption. Using the HEART (History, ECG, Age, Risk factors and Troponin) score, low-risk patients are easily identified. When a point-of-care (POC) troponin measurement is included in the HEART score, an ACS can adequately be ruled out in low-risk patients in the prehospital setting. However, it remains unclear whether a prehospital rule-out strategy using the HEART score and a POC troponin measurement in patients with suspected NSTE-ACS is cost-effective.Methods and analysisThe ARTICA trial is a randomised trial in which the primary objective is to investigate the cost-effectiveness after 30 days of an early rule-out strategy for low-risk patients suspected of a NSTE-ACS, using a modified HEART score including a POC troponin T measurement. Patients are included by ambulance paramedics and 1:1 randomised for (1) presentation at the ED (control group) or (2) POC troponin T measurement (intervention group) and transfer of the care to the general practitioner in case of a low troponin T value. In total, 866 patients will be included. Follow-up will be performed after 30 days, 6 months and 12 months.Ethics and disseminationThis trial has been accepted by the Medical Research Ethics Committee region Arnhem-Nijmegen. The results of this trial will be disseminated in one main paper and in additional papers with subgroup analyses.Trial registration numberNetherlands Trial Register (NL7148).