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
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Le résumé fourni par la source
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.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- 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
- Date Crossref
- 17/01/2024
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Radboud University Nijmegen pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Medical Center pays non établi dans la noticeOrganisme public
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GGD Zuid Limburg pays non établi dans la noticeOrganisme public
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Ontwikkelingsmaatschappij Oost Nederland pays non établi dans la noticeOrganisation à but non lucratif
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GGD Limburg-Noord pays non établi dans la noticeOrganisme public
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Canisius-Wilhelmina Ziekenhuis pays non établi dans la noticeÉtablissement de santé
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Radboud University Medical Centre Department of Cardiology pays non établi dans la noticeUniversité ou école supérieure
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Radboud Institute for Health Sciences Department of Health Evidence pays non établi dans la noticeStructure de recherche
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Ambulance Service pays non établi dans la noticeInstitution
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General Practitioner Centre Nijmegen and Boxmeer pays non établi dans la noticeInstitution
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General Practitioner Cooperative Noord-Limburg pays non établi dans la noticeInstitution
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Canisius Wilhelmina Hospital Department of Cardiology pays non établi dans la noticeÉtablissement de santé
Radboud University Nijmegen, Radboud University Medical Center et GGD Zuid Limburg, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.