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Predictors of Risk Stratification and Value of Point-of-Care of High-Sensitivity Cardiac Troponin-I in EMS Management of Non-ST-Segment Elevation Myocardial Infarction: A Retrospective Study

Published online by Cambridge University Press:  28 April 2022

Thomas Pavlovsky ,
Mathias Obadia ,
Stéphanie Ragot ,
Benedicte Douay ,
Enrique Casalino  and
Daniel Aiham Ghazali Open the ORCID record for Daniel Aiham Ghazali [Opens in a new window]
Thomas Pavlovsky
Affiliation:
Emergency Medical Services, Beaujon University Hospital, Clichy, France Emergency Department, Bichat University Hospital, AP-HP, Hôpital Bichat, Paris, France
Mathias Obadia
Affiliation:
Emergency Medical Services, Beaujon University Hospital, Clichy, France
Stéphanie Ragot
Affiliation:
Clinical Investigation Center CIC-INSERM1402, Poitiers University Hospital, Poitiers, France
Benedicte Douay
Affiliation:
Emergency Medical Services, Beaujon University Hospital, Clichy, France
Enrique Casalino
Affiliation:
Emergency Medical Services, Beaujon University Hospital, Clichy, France Emergency Department, Bichat University Hospital, AP-HP, Hôpital Bichat, Paris, France IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM UMR1137, University of Paris, Paris, France
Daniel Aiham Ghazali*
Affiliation:
IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM UMR1137, University of Paris, Paris, France Emergency Department and EMS, Amiens University Hospital, Amiens, France
*
Correspondence: Daniel Aiham Ghazali, MD, PhD IAME Research Center, INSERM UMR 1137 University of Paris 16 rue Henri Huchard, B.P. 416 75870 Paris Cedex 18, France Emergency Department and EMS University Hospital of Amiens Rond-Point du Pr Christian Cabrol 80000 Amiens, France E-mail: [email protected]; [email protected]
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Abstract

Introduction:

The European Society of Cardiology (ESC) 2020 guidelines propose an algorithm for in-hospital management of non-ST-elevation myocardial infarction (NSTEMI) based on risk stratification according to clinical, electrocardiographic, and biological data. However, out-of-hospital management is not codified.

Study Objective:

The objective of the present study was to evaluate the role of high-sensitivity cardiac troponin-I in out-of-hospital management of NSTEMI by Emergency Medical Services (EMS).

Methods:

This monocentric, retrospective, observational study analyzed the files of all patients having received a troponin assay in the EMS of Beaujon University Hospital, AP-HP (Paris region, France) from January 1, 2020 through December 31, 2020. Patients were classified as low risk, high risk, or very high risk according to the ESC 2020 algorithm at the time of their hospital treatment. The relationship between troponin in point-of-care and risk level according to time to onset of pain was analyzed using logistic regression. A search for predictors of risk level was performed using multivariate analysis. A P value <.05 was considered significant.

Results:

Out of 309 patients in the file, 233 were included. Men were 61% and the median age was 63 years. A positive troponin assay was associated with high-risk or very high-risk stratification regardless of the time to onset of pain (P <.0001). Predictive factors for being classified as high or very high risk in hospital were: a history of atrial fibrillation (P = .03), electrocardiogram (ECG) modifications such as negative T wave or ST-segment depression (P <.0001), and positive troponin (P <.0001).

Conclusion:

The use of point-of-care troponin in EMS, combined with clinical and electrical criteria, allows risk stratification of NSTEMI patients from the prehospital management stage and optimization of referral to an appropriate care pathway. Patients classified as low risk should be referred to the emergency department (ED) and patients classified as high risk or very high risk to the cardiac intensive care unit or percutaneous coronary intervention (PCI) center.

Keywords

EMSNSTEMIpoint-of-carerisk stratificationtroponin
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 3 , June 2022 , pp. 365 - 372
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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