Ambulance triage using a risk score and blood test for suspected heart attack
Tests ambulance triage using a risk score and rapid troponin test in adults.
Plain-language title generated from the registry record
Registry title: Pre Hospital Triage of Patients at Intermediate and High Risk for ACS
Key facts
- Where
- Haps and Nijmegen, NetherlandsSee the 3 sites
Where in Netherlands
- RAV Brabant midden-west-noord: post HapsHaps, NetherlandsTaking people
- Radboudumc Nijmegen, The NetherlandsNijmegen, NetherlandsTaking people
- Veiligheidsregio Gelderland-ZuidNijmegen, NetherlandsNot yet recruiting
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- Cyril Camaro
- Trial code
- NCT07252245
- Record updated
- 10 September 2026
- Original description
RESEARCH QUESTION: Is a treatment strategy that includes direct referral to a PCI center for intermediate to high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS), both cost-effective and non-inferior for major adverse cardiac events (MACE)? HYPOTHESIS: Prehospital triage with the modified [History-ECG-Age-Risk factors] (HEAR) score and a high sensitivity (hs) point-of-care troponin (POCT) leads to a faster diagnosis of ACS, faster time to coronary angiography (CAG) and/or treatment with PCI, shorter length of stay, quicker availability of ambulances and more satisfaction and quality of life of patients. STUDY DESIGN: Randomized clinical trial. STUDY POPULATION: Patients ≥18 years with an intermediate to high risk for NSTE -ACS (defined as a modified HEAR score ≥ 4) INTERVENTION: applying modified HEAR score and hs POCT to identify patients for direct rule out (very low risk), transfer to the nearest hospital for rapid rule-out and/or fast-track diagnosis by CT coronary imaging (intermediate risk) or direct referral to a PCI center for CAG (high risk).Read full original descriptionShow less
Pre Hospital Triage of Patients at Intermediate and High Risk for ACS: ARTICA-2 Trial
RESEARCH QUESTION: Is a treatment strategy that includes direct referral to a PCI center for intermediate to high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS), both cost-effective and non-inferior for major adverse cardiac events (MACE)? HYPOTHESIS: Prehospital triage with the modified [History-ECG-Age-Risk factors] (HEAR) score and a high sensitivity (hs) point-of-care troponin (POCT) leads to a faster diagnosis of ACS, faster time to coronary angiography (CAG) and/or treatment with PCI, shorter length of stay, quicker availability of ambulances and more satisfaction and quality of life of patients. STUDY DESIGN: Randomized clinical trial. STUDY POPULATION: Patients ≥18 years with an intermediate to high risk for NSTE -ACS (defined as a modified HEAR score ≥ 4) INTERVENTION: applying modified HEAR score and hs POCT to identify patients for direct rule out (very low risk), transfer to the nearest hospital for rapid rule-out and/or fast-track diagnosis by CT coronary imaging (intermediate risk) or direct referral to a PCI center for CAG (high risk).
USUAL CARE/COMPARISON: Assessment of ACS at the nearest hospital. In case PCI is scheduled: transfer to nearest PCI center.
OUTCOME MEASURES: primary endpoints: healthcare costs and non-inferiority for MACE (all cause death, confirmed ACS, re ACS, and unplanned PCI or CABG) at 30 days. Secondary: MACE after rule out ACS at 30 days, Quality of life (EQ5D5L) and cost-effectiveness at 12 months.
SAMPLE SIZE: 1048 patients. COST-EFFECTIVENESS ANALYSIS / BIA: It is expected that the intervention group will reduce healthcare costs and potentially improve health-related quality of life in this target population. Cost-effectiveness will be expressed as cost per QALY gained. We assume a large potential saving more than € 37 million if 100% implemented. TIME SCHEDULE: 48 months; 36 month inclusion, follow-up 12 months
Inclusion: 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: 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 with known cognitive impairment; 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 signs of heart failure; Any significant medical or mental condition, which in the Investigator's opinion may interfere with the patient's optimal participation in the study; Patients with known end-stage renal disease (dialysis and/or GFR < 30 ml/min); Electrocardiographic ST-segment elevation (STEMI); Patients in comatose state, defined as an EMV <8; Pregnancy; Patients presenting with syncope; 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 without a pre-hospital 12-lead ECG performed or available; Patients suspicious of aortic dissection or pulmonary embolism; Communication issues with patient/language barrier.