Patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) often require evaluation in the emergency department (ED). However, a pre-hospital rule-out strategy using a point-of-care (POC) troponin measurement may identify low-risk patients who can avoid unnecessary ED visits. The ARTICA trial aimed to assess the safety and healthcare costs of such a strategy of pre-hospital rule-out of ACS.
The randomized clinical trial was conducted in five different ambulance regions in the Netherlands. Patients with suspected NSTE-ACS and a HEAR (History, ECG, Age, Risk factors) score ≤3 were randomly assigned to either pre-hospital rule-out with POC troponin measurement or direct transfer to the ED. A total of 863 participants were included. Interestingly, healthcare costs were significantly lower in the pre-hospital strategy group (€1349 ± €2051) compared to the direct ED transfer group (€1960 ± €1808), with a mean difference of €611 (95% CI: 353–869; P < 0.001). The incidence of major adverse cardiac events (MACE) at 30 days was comparable between the two groups in the total population (3.9% vs. 3.7%, P = 0.89). In the ruled-out ACS population, the incidence of MACE was very low (0.5% vs. 1.0%), with a risk difference of -0.5% (95% CI: -1.6%–0.7%; P = 0.41) favoring the pre-hospital strategy.
The pre-hospital rule-out strategy of ACS using POC troponin measurement in low-risk patients resulted in significantly lower healthcare costs. Furthermore, the incidence of MACE was low in both the pre-hospital and direct ED transfer groups. Implementing this strategy can potentially reduce healthcare costs and optimize resource utilization, while maintaining patient safety in low-risk NSTE-ACS cases.