• Maycel Ishak, Danish Ali, Marion J Fokkert, Robbert J Slingerland, Rudolf T Tolsma, Erik Badings, Aize van der Sluis, Fred van Eenennaam, Arend Mosterd, Jurriën M Ten Berg, and Arnoud Wj van 't Hof.
• 1 Department of Cardiology, Isala Hospital, The Netherlands.
• Eur Heart J Acute Cardiovasc Care. 2018 Mar 1; 7 (2): 102-110.

BackgroundThe 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.MethodsA 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.ResultsTwo 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.ConclusionIt seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score.Trial IdNTR4205. Dutch Trial Register [ http://www.trialregister.nl ]: trial number 4205.

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