# Prehospitale troponine voor uitsluiting NSTE-ACS: gerandomiseerde trial

*geplaatst 2023-05-14 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehad056 · https://hartvaat.nl/2023/05/14/prehospitale-troponine-voor-uitsluiting-nste-acs-gerandomiseerde-trial/*

Trial onderzocht of een enkele prehospitale troponinebepaling NSTE-ACS veilig kan uitsluiten. De strategie identificeerde laagrisicopatiënten die veilig naar huis konden zonder SEH-beoordeling, wat de zorgketen kan ontlasten.

## English: Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial.

This trial explored whether a single prehospital troponin measurement can safely rule out NSTE-ACS in the ambulance setting, potentially enabling faster triage and reducing unnecessary emergency department transfers.

## Abstract (original, from the publication)

AIMS: 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 MACE was low in both strategies. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT05466591 and International Clinical Trials Registry Platform id NTR 7346.

Auteurs: Cyril Camaro, Goaris W A Aarts, Eddy M M Adang, Roger van Hout, Gijs Brok, Anouk Hoare, Laura Rodwell, Frank de Pooter, Walter de Wit, Gilbert E Cramer, Roland R J van Kimmenade, Peter Damman, Eva Ouwendijk, Martijn Rutten, Erwin Zegers, Robert-Jan M van Geuns, Marc E R Gomes, Niels van Royen

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehad056. Bijgewerkt 2026-07-03T13:29:26Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.