title: Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score.
abstract: BACKGROUND
  The first study of the FamouS Triage project investigates the feasibility of ruling out a myocardial infarction in pre-hospital chest pain patients without electrocardiographic ST-segment elevation by using the modified HEART score at the patient's home, incorporating only a single highly sensitive troponin T measurement.
  
  
  METHODS
  A venous blood sample was drawn in the ambulance from 1127 consecutive chest pain patients for measurement of the pre-hospital highly sensitive troponin T levels, in order to establish a pre-hospital HEART score (i.e. the modified HEART score) and evaluate the possibility of triage at the patient's home. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) i.e. acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or death within 30 days after initial presentation.
  
  
  RESULTS
  Two hundred and six patients (18%) developed a MACE during 30 days of follow-up. Thirty-six per cent of the patients ( n=403) had a low modified HEART score (0-3 points) and none of them developed a MACE during follow-up. Forty-four per cent of the patients ( n=494) had an intermediate modified HEART score (4-6 points) and 18% of them developed a MACE. Twenty per cent of the patients ( n=230) had a high modified HEART score (7-10 points) of which 52% developed a MACE during follow-up.
  
  
  CONCLUSIONS
  It seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score.
  
  
  BACKGROUND
  NTR4205. Dutch Trial Register [ http://www.trialregister.nl ]: trial number 4205.
authors.affiliation: 1 Department of Cardiology, Isala Hospital, The Netherlands.
authors.forename: Maycel
authors.initials: M
authors.lastname: Ishak
authors.affiliation: 2 Department of Cardiology, University Hospital Coventry, UK.
authors.forename: Danish
authors.initials: D
authors.lastname: Ali
authors.affiliation: 3 Department of Clinical Chemistry, Isala Hospital, The Netherlands.
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Fokkert
authors.affiliation: 3 Department of Clinical Chemistry, Isala Hospital, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: Slingerland
authors.affiliation: 4 Regional Ambulance Service IJsselland, Zwolle, The Netherlands.
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Tolsma
authors.affiliation: 5 Department of Cardiology, Deventer Ziekenhuis, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Badings
authors.affiliation: 5 Department of Cardiology, Deventer Ziekenhuis, The Netherlands.
authors.forename: Aize
authors.initials: A
authors.lastname: van der Sluis
authors.affiliation: 6 The Decision Group, Amsterdam, The Netherlands.|7 Erasmus School of Accounting & Assurance, Erasmus University, The Netherlands.
authors.forename: Fred
authors.initials: F
authors.lastname: van Eenennaam
authors.affiliation: 8 Department of Cardiology, Meander Medical Centre, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.affiliation: 9 Department of Cardiology, St Antonius Hospital, The Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.affiliation: 1 Department of Cardiology, Isala Hospital, The Netherlands.
authors.forename: Arnoud Wj
authors.initials: AW
authors.lastname: van 't Hof
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014218:Triage / Q000379:methods*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Pre-hospital triage; acute myocardial infarction; chest pain; highly sensitive troponin; modified HEART score; non-ST-segment elevation acute coronary syndrome