Prehospital triage in suspected myocardial infarction: a calculated risk?

In the prehospital setting, accurate decision-making is of paramount importance in the management of cardiac emergencies. For life-threatening events involving complete occlusion of a coronary artery, the activation of ST-elevation myocardial infarction protocols instructs the emergency services to provide immediate treatment and liaise directly with cardiac centres regarding invasive management, in turn, reducing morbidity and saving lives. Yet, when the coronary artery is only partially occluded in the context of non-ST-elevation acute coronary syndrome (NSTE-ACS), the prehospital diagnostic work-up and subsequent invasive strategies lack a strong evidence base. In most countries, the pressurised and overcrowded environment of the emergency department serves as the intermediary to discriminate a plaque rupture event from other causes of chest pain. A patient’s journey through the emergency department to a cardiology service is frequently triaged by high-sensitivity troponin measurement, with abnormal levels noted in approximately 20% with a suspected NSTE-ACS.1 In this...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research