CLINICAL
NEWS
American College of Cardiology Extended Learning
ACCEL interviews and topical summaries of cardiology’s
most interesting research areas
Rapid Rule Out: How PROACTive Should EMS Be?
N
oncardiac chest pain (NCCP) is
defined as recurring anginalike substernal chest pain of
noncardiac origin. That’s straightforward; what to do about it, most certainly, is not. It is very common, affecting
roughly 25% of the adult population in
the United States.1,2 To put that in perspective, NCCP is as common as having
medium brown to blonde hair (24% of
the world population).
With that kind of prevalence,
you can imagine that chest pain and
symptoms consistent with myocardial
ischemia are among the most common
reasons for emergency department
(ED) evaluation, accounting for approximately 5.2% (or 7.1 million) of the
136 million ED visits each year. That’s
according to the National Hospital
Ambulatory Medical Care Survey: 2011
Emergency Department Summary
(made available in 2015). This puts
chest pain as the second most common
reason for an ED visit, behind stomach/
abdominal pain (11.1 million) but
ahead of fever (5.1 million visits).
The majority of these chest
pain patients are ultimately discovered
to have NCCP, leading to speculation
that these patients should be able to be
more effectively and rapidly managed.
Troponin testing in the ED is the
standard of care for patients with
chest pain to “rule out” an acute
cardiac event. Recent advances in the
sensitivity of troponin has led to earlier, more precise detection of events;
can such testing be moved up and out
of the ED?
PEOPLE ARE COUNTING ON
THIS MIDDLE-AGED FATHER OF 3...
EFFIENT® (PRASUGREL)
CAN HELP
PROTECT
HIM AFTER
STEMI-PCI
PROACT
Investigators wondered whether
prehospital point-of-care (POC) troponin—done in the ambulance—might
accelerate time to diagnosis in patients
with chest pain. The randomized trial,
known as PROACT-3 (Providing Rapid
Out of Hospital Acute Cardiovascular
Treatment 3), was disappointing.3 Justin A. Ezekowitz, MD, and colleagues
at the University of Alberta and other
provincial centers, found that prehospital testing of B-type natriuretic
20 CardioSource WorldNews
Learn more at EffientHCP.com