ORLANDO, Fla. — Among patients with suspected acute cardiovascular disease, drawing and analyzing troponin in the ambulance was associated with a trend toward a shorter time from first medical contact to final disposition in the emergency department (ED) compared with usual care.

Justin A. Ezekowitz, MD, of the University of Alberta in Alberta, Canada, presented the findings of the PROACT-4 trial at the American Heart Association Scientific Sessions.

In the randomized controlled PROACT-3 trial, Dr Ezekowitz and colleagues found that point-of-care (POC) troponin testing did not impact the primary outcome of time to final disposition. “We redid the methodology of the trial and that [resulted in] the PROACT-4 trial,”said Dr Ezekowitz  during a press conference.


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The 2 objectives of the PROACT-4 trial were to determine whether measurement of point-of-care (POC) troponin in the ambulance enabled a shorter time from first medical contact to final patient disposition in the ED, and was associated with decreased 30-day clinical events in patients presenting with chest pain in an ambulance.

In all, 601 patients (median age, 66 years; 57% male) were randomly assigned to receive either usual care (n=296) or POC troponin (n=305). Those in the POC troponin arm had a high-sensitivity troponin drawn and analyzed on a POC device in the ambulance, with results available for the paramedic and ED staff.

Time from first medical contact to final ED disposition served as the primary end point.

Results revealed that once the 911 calls were placed, the median time for availability of first troponin was 138 minutes in the usual care group and 38 minutes in the POC troponin group. In the POC troponin arm, troponin was >0.01 ng/mL in 17.4% of patients and >0.03 ng/mL in 9.8% of patients.

Researchers reported a trend toward a reduction in median time from first medical contact to final ED disposition with POC troponin compared with usual care in both the intention-to-treat (8.85 hours vs 9.14 hours; adjusted P=.074) and per-protocol (8.75 hours vs 9.14 hours; adjusted P=.059) analyses.

Secondary end point analysis revealed no significant differences between groups in repeat ED visits, hospitalizations or death at 30 days in either the per-protocol or intention-to-treat analysis.

“The point of care troponin in the ambulance shortened time to final disposition in the ED, although this was not statistically significant,” said Dr Ezekowitz. “The majority of patients presenting to the [emergency room (ER)] … by ambulance with chest pain are at low risk.”

Going forward, Dr Ezekowitz said that POC troponin will continue to evolve, leading to increased speed, ease, and sensitivity.

“This will provide a potential opportunity for a low-risk population to streamline pre-ER and pre-ED care, as well as in a high-risk population [the potential] to triage and [for] prehospital therapy.”

Disclosures: Dr Ezekowitz reports no relevant financial disclosures.

Reference

  1. Ezekowitz  JA. LBCT III: ACS and PCI: The Continuum of Care. Providing Rapid Out of Hospital Acute Cardiovascular Treatment: PROACT-4. Presented at: American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.