Goal
Prehospital danger stratification and triage are at the moment not carried out in sufferers suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may occasionally result in extended time to revascularisation, elevated length of hospital admission and better healthcare prices. The preHEART rating (prehospital historical past, ECG, age, danger components and point-of-care troponin rating) can be utilized by emergency medical companies (EMS) personnel for prehospital danger stratification and triage choices in sufferers with NSTE-ACS. The goal of the present examine was to judge the impact of prehospital danger stratification and direct switch to a percutaneous coronary intervention (PCI) centre, based mostly on the preHEART rating, on time to last invasive diagnostics or wrongdoer revascularisation.
Strategies
Potential, multicentre, two-cohort examine in sufferers with suspected NSTE-ACS. The primary cohort is observational (commonplace care), whereas the second (interventional) cohort contains sufferers who’re stratified for direct switch to both a PCI or a non-PCI centre based mostly on their preHEART rating. Threat stratification and triage are carried out by EMS personnel. The first endpoint of the examine is time from first medical contact till last invasive diagnostics or revascularisation. Secondary endpoints are time from first medical contact till intracoronary angiography (ICA), length of hospital admission, variety of invasive diagnostics, variety of inter-hospital transfers and main opposed cardiac occasions at 7 and 30 days.
Outcomes
A complete of 1069 sufferers have been included. Within the interventional cohort (n=577), time between last invasive diagnostics or revascularisation (42 (17–101) hours vs 20 (5–44) hours, p<0.001) and size of hospital admission (3 (2–5) days vs 2 (1–4) days, p=0.007) have been shorter than within the observational cohort (n=492). In sufferers with NSTE-ACS in want for ICA or revascularisation, healthcare prices have been lowered within the interventional cohort (5599 (2978–9625) vs 4899 (2278–5947), p=0.02).
Conclusion
Prehospital danger stratification and direct switch to a PCI centre, based mostly on the preHEART rating, reduces time from first medical contact to last invasive diagnostics and revascularisation, reduces length of hospital admission and reduces healthcare prices in sufferers with NSTE-ACS in want for ICA or revascularisation.
Trial registration
NCT05243485.