title: Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway: rationale and design.
abstract: BACKGROUND
  For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy for diagnosis, medication regimen and logistics. The FAMOUS TRIAGE study will assess the effects of introducing a pre-hospital triage system that reliably stratifies chest pain patients without ST-segment elevation into 1) patients at high risk for NSTEMI requiring a direct transfer to a PCI-hospital; 2) patients at intermediate risk for a major adverse cardiac event (MACE) who could be evaluated at the nearest non-PCI hospital; and 3) patients at low risk for MACE (benign non-cardiac chest pain) who could have further evaluation at home or in a primary care setting.
  
  
  METHODS
  The FAMOUS TRIAGE study will be performed in three phases. In the first phase an appropriate pre-hospital risk stratification tool will be designed for chest pain patients without ST-segment elevation by means of a retrospective and a prospective study. The second phase of the project represents the external validation of the risk stratification models, and in the third and final phase an optimal risk stratification tool will be implemented into clinical practice. Clinical and economical endpoints before and after implementation of the pre-hospital risk stratification tool will be compared to assess clinical benefit and cost-effectiveness.
  
  
  CONCLUSIONS
  The FAMOUS TRIAGE project is a triple phase study that aims to optimize the pre-hospital management of chest pain patients without ST-segment elevation by providing tools for pre-hospital identification of NSTEMI or exclusion of acute coronary syndrome at home.
  
  
  BACKGROUND
  NTR4205. Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Maycel
authors.initials: M
authors.lastname: Ishak
authors.affiliation: Department of Cardiology, Isala Zwolle, The Netherlands.
authors.forename: Danish
authors.initials: D
authors.lastname: Ali
authors.affiliation: Department of Clinical Chemistry, Isala Zwolle, The Netherlands.
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Fokkert
authors.affiliation: Department of Clinical Chemistry, Isala Zwolle, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: Slingerland
authors.affiliation: Department of Clinical Chemistry, Isala Zwolle, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Dikkeschei
authors.affiliation: Regional Ambulance Service IJsselland (abbreviation in Dutch: RAV IJsselland) - Zwolle, The Netherlands.
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Tolsma
authors.affiliation: Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Lichtveld
authors.affiliation: Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Bruins
authors.affiliation: Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Boomars
authors.affiliation: The Decision Group Amsterdam, The Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: Bruheim
authors.affiliation: The Decision Group Amsterdam, The Netherlands Erasmus School of Accounting and Assurance (ESAA), Erasmus University Rotterdam, The Netherlands.
authors.forename: Fred
authors.initials: F
authors.lastname: van Eenennaam
authors.affiliation: Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Timmers
authors.affiliation: Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.affiliation: Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: Department of Cardiology, Meander Medical Center Amersfoort, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
authors.affiliation: Department of Cardiology, Isala Zwolle, The Netherlands a.w.j.vant.hof@isala.nl.
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: ACS; AMI; Acute coronary syndrome; FAMOUS TRIAGE; NSTEMI; UA; acute myocardial infarction; ambulance; chest pain; high-sensitive troponin; modified HEART score; non ST-elevation acute coronary syndrome; non ST-elevation myocardial infarction; nonSTEMI; paramedic; pre-hospital; risk stratification; triage; unstable angina