Prehospital triage for intermediate- to high-risk NSTE-ACS using HEAR score and hs troponin

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

Adults with suspected ACS who are at intermediate to high risk (HEAR score ≥ 4) are randomized to a prehospital triage pathway using the HEAR score and high-sensitivity point-of-care troponin to guide direct referral to PCI-capable centers for rapid rule-out and treatment when appropriate, or standard triage. The study compares 30-day MACE rates and costs between strategies, with secondary aims including 30-day MACE after rule-out and long-term cost-effectiveness and quality of life at 12 months. This is a pragmatic randomized trial set in the Netherlands, enrolling about 1,048 participants to reflect real-world prehospital care. The intervention aims to shorten time to coronary angiography or PCI, improve ambulance availability, and enhance patient satisfaction.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Age ≥ 18 years
* All out-of-hospital patients with chest pain or symptoms suggestive of ACS with an indication for transfer to the (cardiac) emergency department to evaluate and rule out ACS
* Modified HEAR(T) score ≥ 4
* The patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent.

Exclusion Criteria:

* Electrocardiographic ST-segment elevation (STEMI)
* Patients with confirmed myocardial infarction, PCI or CABG \<14 days prior to inclu-sion
* 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 \<8
* Patients with known cognitive impairment
* Pregnancy
* Patients presenting with cardiogenic shock, defined as: systolic blood pressure \<90mmHg and heart rate \>100 and peripheral oxygen saturation \<90% (without oxygen administration)
* Patients presenting with syncope
* Patients presenting with signs of heart failure
* Patients presenting with second or third degree atrioventricular block
* Patients without known supraventricular tachycardia i.e. unknown atrial fibrillation (known atrial fibrillation with adequate rate control can be included)
* Patients with known end-stage renal disease (dialysis and/or GFR \< 30 ml/min)
* Patients without a pre-hospital 12-lead ECG performed or available
* Patients suspicious of aortic dissection or pulmonary embolism
* Communication issues with patient/language barrier
* Any significant medical or mental condition, which in the Investigator's opinion may interfere with the patient's optimal participation in the study

Where it's running

• RAV Brabant midden-west-noord: post Haps
  Haps, Netherlands Recruiting
• Radboudumc Nijmegen, The Netherlands
  Nijmegen, Netherlands Recruiting
• Veiligheidsregio Gelderland-Zuid
  Nijmegen, Netherlands Not yet recruiting

Study contacts

• Principal investigator: Cyril Camaro, MD — Radboudumc / department Cardiology 616
• Study coordinator: Cyril Camaro, MD
• Email: articastudie.cardio@radboudumc.nl
• Phone: +31243616785

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.