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Randomized Controlled Trial
. 2024 Aug 8;10(5):411-420.
doi: 10.1093/ehjqcco/qcae004.

Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial

Goaris W A Aarts  1 , Cyril Camaro  1 , Eddy M M Adang  2 , Laura Rodwell  2 , Roger van Hout  3 , Gijs Brok  3 , Anouk Hoare  4 , Frank de Pooter  5 , Walter de Wit  6 , Gilbert E Cramer  1 , Roland R J van Kimmenade  1 , Eva Ouwendijk  7 , Martijn H Rutten  8 , Erwin Zegers  9 , Robert-Jan M van Geuns  1 , Marc E R Gomes  9 , Peter Damman  1 , Niels van Royen  1
Affiliations
Randomized Controlled Trial

Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial

Goaris W A Aarts et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Background and aims: The healthcare burden of acute chest pain is enormous. In the randomized ARTICA trial, we showed that pre-hospital identification of low-risk patients and rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with point-of-care (POC) troponin measurement reduces 30-day healthcare costs with low major adverse cardiac events (MACE) incidence. Here we present the final 1-year results of the ARTICA trial.

Methods: Low-risk patients with suspected NSTE-ACS were randomized to pre-hospital rule-out with POC troponin measurement or emergency department (ED) transfer. Primary 1-year outcome was healthcare costs. Secondary outcomes were safety, quality of life (QoL), and cost-effectiveness. Safety was defined as a 1-year MACE consisting of ACS, unplanned revascularization, or all-cause death. QoL was measured with EuroQol-5D-5L questionnaires. Cost-effectiveness was defined as 1-year healthcare costs difference per QoL difference.

Results: Follow-up was completed for all 863 patients. Healthcare costs were significantly lower in the pre-hospital strategy (€1932 ± €2784 vs. €2649 ± €2750), mean difference €717 [95% confidence interval (CI) €347 to €1087; P < 0.001]. In the total population, the 1-year MACE rate was comparable between groups [5.1% (22/434) in the pre-hospital strategy vs. 4.2% (18/429) in the ED strategy; P = 0.54]. In the ruled-out ACS population, 1-year MACE remained low [1.7% (7/419) vs. 1.4% (6/417)], risk difference 0.2% (95% CI -1.4% to 1.9%; P = 0.79). QoL showed no significant difference between strategies.

Conclusions: Pre-hospital rule-out of NSTE-ACS with POC troponin testing in low-risk patients is cost-effective, as expressed by a sustainable healthcare cost reduction and no significant effect on QoL. One-year MACE remained low for both strategies.

Keywords: Acute coronary syndrome; Ambulance; Cost-effectiveness; Healthcare economics; Point-of-care troponin.

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Figures

Graphical Abstract
Graphical Abstract
Overview of the study design and outcomes.
Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Incidence of major adverse cardiac events at 1 year.
Figure 3
Figure 3
Cumulative incidence curve for the incidence of major adverse cardiac events at 1 year.
Figure 4
Figure 4
Mean healthcare costs (A), EQ-5D-5L utility scores (B), CE plane (C) and CEAC (D).
See this image and copyright information in PMC

Comment in

  • Ambulance drive-thru troponin, ready to go?
    Bueno H, Bardají A. Bueno H, et al. Eur Heart J Qual Care Clin Outcomes. 2024 Aug 8;10(5):384-385. doi: 10.1093/ehjqcco/qcae023. Eur Heart J Qual Care Clin Outcomes. 2024. PMID: 38692850 No abstract available.

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