Providing Rapid Out of Hospital Acute Cardiovascular Treatment - PROACT-4

Description:

The goal of the trial was to evaluate point of care troponin testing in the ambulance compared with usual care among patients presenting to the hospital with chest pain.

Contribution to the Literature: The PROACT-4 trial failed to show that point of care troponin testing shortened the time from first medical contact to final disposition in the emergency department.

Study Design

  • Randomized
  • Parallel

Patients en route to the hospital with acute chest pain were randomized to point of care troponin testing (n = 305) versus usual care (n = 296).

  • Total number of enrollees: 601
  • Duration of follow-up: Hospitalization
  • Mean patient age: 64 years
  • Percentage female: 41%
  • Percentage diabetics: 26%

Other salient features/characteristics:

  • First troponin results available: 38 minutes with point of care testing vs. 138 minutes with usual care (p < 0.001)
  • In the point of care group: 64% had troponin I ≤0.01, 17% had troponin I >0.01, and 10% had troponin I >0.03

Inclusion criteria:

  • Patients ages ≥30 years activating prehospital emergency medical service for acute chest discomfort

Exclusion criteria:

  • ST-segment elevation myocardial infarction
  • Cardiac arrest
  • Diagnosis that is compatible with another disease

Principal Findings:

The primary outcome, time from first medical contact to final disposition in the emergency department, was 8.9 hours in the point of care group versus 9.1 hours in the usual care group (p = 0.074). In a per-protocol analysis, this difference achieved marginal significance (p = 0.059).

Secondary outcomes for all-cause death were 1.3% for point of care vs. 1.4% for usual care (p = 0.97).

Interpretation:

Among patients presenting to the hospital with acute chest pain, point of care troponin testing in the ambulance nonsignificantly reduced the time from first medical contact to final disposition in the emergency department. The majority of patients presenting to the emergency department with acute chest pain are low risk.

References:

Presented by Dr. Justin Ezekowitz at the American Heart Association Scientific Sessions, Orlando, FL, November 10, 2015.


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