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Original research
Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome
  1. Jesse Demandt1,
  2. Arjan Koks2,
  3. Dennis Sagel3,
  4. Veerle A E van Hattem1,
  5. Rutger J Haest4,5,
  6. Eric Heijmen5,6,
  7. H Thijssen5,7,
  8. Luuk C Otterspoor1,
  9. Dennis van Veghel1,5,
  10. Rob Eerdekens1,
  11. Mohamed el Farissi1,
  12. Koen Teeuwen1,
  13. Inge Wijnbergen1,
  14. Pim van der Harst1,
  15. Nico H J Pijls8,
  16. Marcel van 't Veer1,3,
  17. Pim A L Tonino8,
  18. Lukas R C Dekker1,8,
  19. Pieter J Vlaar1,5
  1. 1 Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
  2. 2 GGD Brabant-Zuidoost, Eindhoven, Netherlands
  3. 3 Cardioresearch, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
  4. 4 Cardiology, St. Anna Hospital, Geldrop, Netherlands
  5. 5 Netherlands Heart Network, Helmond, Netherlands
  6. 6 Cardiology, Elkerliek Hospital, Helmond, Netherlands
  7. 7 Cardiology, Maxima Medical Centre, Veldhoven, Netherlands
  8. 8 Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
  1. Correspondence to Dr Pieter J Vlaar, Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands; pieter-jan.vlaar{at}catharinaziekenhuis.nl

Abstract

Objective Prehospital risk stratification and triage are currently not performed in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may lead to prolonged time to revascularisation, increased duration of hospital admission and higher healthcare costs. The preHEART score (prehospital history, ECG, age, risk factors and point-of-care troponin score) can be used by emergency medical services (EMS) personnel for prehospital risk stratification and triage decisions in patients with NSTE-ACS. The aim of the current study was to evaluate the effect of prehospital risk stratification and direct transfer to a percutaneous coronary intervention (PCI) centre, based on the preHEART score, on time to final invasive diagnostics or culprit revascularisation.

Methods Prospective, multicentre, two-cohort study in patients with suspected NSTE-ACS. The first cohort is observational (standard care), while the second (interventional) cohort includes patients who are stratified for direct transfer to either a PCI or a non-PCI centre based on their preHEART score. Risk stratification and triage are performed by EMS personnel. The primary endpoint of the study is time from first medical contact until final invasive diagnostics or revascularisation. Secondary endpoints are time from first medical contact until intracoronary angiography (ICA), duration of hospital admission, number of invasive diagnostics, number of inter-hospital transfers and major adverse cardiac events at 7 and 30 days.

Results A total of 1069 patients were included. In the interventional cohort (n=577), time between final invasive diagnostics or revascularisation (42 (17–101) hours vs 20 (5–44) hours, p<0.001) and length of hospital admission (3 (2–5) days vs 2 (1–4) days, p=0.007) were shorter than in the observational cohort (n=492). In patients with NSTE-ACS in need for ICA or revascularisation, healthcare costs were reduced in the interventional cohort (€5599 (2978–9625) vs €4899 (2278–5947), p=0.02).

Conclusion Prehospital risk stratification and direct transfer to a PCI centre, based on the preHEART score, reduces time from first medical contact to final invasive diagnostics and revascularisation, reduces duration of hospital admission and decreases healthcare costs in patients with NSTE-ACS in need for ICA or revascularisation.

Trial registration NCT05243485.

  • Acute Coronary Syndrome
  • Myocardial Infarction
  • Chest Pain
  • Biomarkers

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study will be made available 1 year after publication upon reasonable request from the corresponding author (PJV).

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study will be made available 1 year after publication upon reasonable request from the corresponding author (PJV).

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Footnotes

  • Twitter @DemandtJesse

  • Contributors Study conception and design: JD, AK, RJH, EH, HT, LCO, DvV, KT, IW, NHJP, MvtV, PALT, LRCD, PJV; data collection: JD, AK, DS, VAEvH, RE, MeF; analysis and interpretation of results: JD, AK, DS, VvH, DvV, RE, MeF, PvdH, NHJP, MvtV, PALT, LRCD, PJV; draft manuscript preparation: JD, AK, DS, VAEvH, RJH, EH, HT, LCO, DvV, RE, MeF, KT, IW, PvdH, NHJP, MvtV, PALT, LRCD, PJV. Guarantor: JD.

  • Funding The study is funded by ZonMw, the Dutch Organisation for Health Research and Development, grant program “Topspecialistische Zorg en Onderzoek”, grant number 10070012010001.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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