Details

Autor(en) / Beteiligte

• Stopyra, Jason P
• Snavely, Anna C
• Smith, Lane M
• Harris, R. David
• Nelson, Robert D
• Winslow, James E
• Alson, Roy L
• Pomper, Gregory J
• Riley, Robert F
• Ashburn, Nicklaus P
• Hendley, Nella W
• Gaddy, Jeremiah
• Woodrum, Tyler
• Fornage, Louis
• Conner, David
• Alvarez, Manrique
• Pflum, Adam
• Koehler, Lauren E
• Miller, Chadwick D
• Mahler, Simon A
• Voskuil, Michiel

Titel

Prehospital use of a modified HEART Pathway and point-of-care troponin to predict cardiovascular events

Ist Teil von

• PloS one, 2020-10, Vol.15 (10), p.e0239460-e0239460

Ort / Verlag

San Francisco: Public Library of Science

Erscheinungsjahr

2020

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• The HEART Pathway is a validated risk stratification protocol for Emergency Department patients with chest pain that has yet to be tested in the prehospital setting. This study seeks to test the performance of a prehospital modified HEART Pathway (PMHP). A prospective cohort study of adults with chest pain without ST-segment elevation myocardial infarction was conducted at three EMS agencies between 12/2016-1/2018. To complete a PMHP assessment, paramedics drew blood, measured point-of-care (POC) troponin (i-STAT; Abbott Point of Care) and calculated a HEAR score. Patients were stratified into three groups: high-risk based on an elevated troponin, low-risk based on a HEAR score <4 with a negative troponin, or moderate risk for a HEAR score [greater than or equal to]4 with a negative troponin. Sensitivity, specificity, negative and positive predictive values of the PMHP for detection of major adverse cardiac events (MACE: cardiac death, MI, or coronary revascularization) at 30-days were calculated. A total of 506 patients were accrued, with PMHP completed in 78.1% (395/506). MACE at 30-days occurred in 18.7% (74/395). Among these patients, 7.1% (28/395) were high risk yielding a specificity and PPV for 30-day MACE of 96.6% (95%CI: 94.0-98.3%) and 60.7% (95%CI: 40.6-78.6%) respectively. Low-risk assessments occurred in 31.4% (124/395), which were 90.5% (95%CI: 81.5-96.1%) sensitive for 30-day MACE with a NPV of 94.4% (95%CI: 88.7-97.7%). Moderate-risk assessments occurred in 61.5% (243/395), of which 20.6% had 30-day MACE. The PMHP is able to identify high-risk and low-risk groups with high specificity and negative predictive value for 30-day MACE.