high-sensitivity troponin i in addition to guideline-based care in ems

Conditions: Emergency Medical Services; Nursing Care; Cardiology; Myocardial Infarction; Myocardial Infarction or Chest Pain; Myocardial Infarction, Acute; Emergencies; Ambulance

Summary: the tiger study is a study investigating the utlility of a point-of-care blood analyse of troponin i to help identify patients with heart attacks in the prehospital emergency care. the study is conducted within the ambulance services of region stockholm and compares standard medical care with and without the addition of this quick test. chest pain is one of the most common reasons for ambulance dispatch, but currently only about one-third of heart attacks are detected before arriving at the hospital-mainly through ecg. the remaining two-thirds are not identified until after further testing at the emergency department. the tiger study aims to improve early diagnosis by using a high-sensitivity, point-of-care troponin i test already in the prehospital phase. the study is a randomized controlled trial, where participants are randomly assigned to one of two groups. one group receives standard emergency care along with the rapid troponin i test in the ambulance. the other group receives standard care without the test. the goal is to evaluate whether the use of troponin i testing leads to faster and more accurate identification of heart attacks, ultimately improving patient outcomes. in total, about 1,419 adult patients with chest pain or suspected heart attack will participate. the primary outcome being measured is the time from first medical contact to pci (balloon angioplasty). secondary outcomes include time spent in different parts of care, hospital length of stay, the occurrence of serious events (such as heart attack, stroke, or death), and the diagnostic accuracy of the test. the study has been approved by the swedish ethical review authority and includes safety monitoring through an interim analysis after the first 150 patients. test results from the troponin i analysis are clearly marked as part of the research study and should be interpreted by the responsible physician alongside other clinical findings.

the tiger study is a prospective, open-label, randomized controlled trial designed to evaluate the clinical utility of prehospital high-sensitivity troponin i testing in patients presenting with chest pain or suspected myocardial infarction (mi). the study is conducted within the emergency medical services (ems) in stockholm, sweden. participants are randomized in a 2:1 ratio to receive either standard guideline-based care alone or standard care plus point-of-care troponin i testing using the siemens atellica® vtli system. the troponin result is available to ems providers in real-time and is communicated to the receiving hospital as part of the routine prehospital handover. the study aims to assess whether the addition of early biomarker data can improve triage, reduce time to treatment (fmc-to-balloon time), and optimize the use of healthcare resources. an interim analysis will be conducted after 150 patients have been enrolled. the study has been approved by the swedish ethical review authority.

Eligibility criteria:
inclusion criteria: * chestpain / discomfort and/or * clinical suspicion of myocardial infarction by the prehospital personeel exclusion criteria: * patients suffering from a trauma and conveyed to the trauma level 1 hospital. * missing valid social security number * not beeing able to give informed consent * not a primary assignment

Keywords: ambulance prehospital emergency nurse sweden point-of-care troponin high sensitive troponin