Journal
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
Volume 8, Issue 4, Pages 299-308Publisher
OXFORD UNIV PRESS
DOI: 10.1177/2048872617745893
Keywords
Acute myocardial infarction; prehospital triage; methods; cardiac troponin; emergency medical services; point-of-care
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Funding
- Roche Diagnostics
- TrygFonden
- Murermester Laurits Peter Christensen og hustru Kirsten Sigrid Christensens Fond
- Aarhus University Hospital Spydspidspuljen at Aarhus University Hospital
- Hjerteforeningen [14-R97-A5237-22813]
- Lundbeck Foundation [R126-2012-11480]
- Laerdal Foundation
- Medicines Company
- Karl G Andersen Foundation
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Objective: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. Methods and results: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012-30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value >= 50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value >= 50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank: p<0.001. The following variables showed the strongest association with mortality in multivariable analysis: point-of-care cardiac troponin T >= 50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90-2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1.74-2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval: 1.27-1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval: 1.08-1.09). Conclusions: Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T >= 50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.
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