Spotlight on Research

Chest pain is a frequent reason for contact with the emergency medical services (EMS). However, it has multiple aetiologies and only a small number of patients are having a myocardial infarction (MI). Risk-stratification for MI is important in order to initiate timely treatment but is typically based upon a 12-lead electrocardiogram (ECG). The limited sensitivity of a 12-lead ECG means that non-ST-elevation myocardial infarction (NSTEMI) can be difficult to identify—yet still requires timely intervention.

This Norwegian study aimed to evaluate the feasibility and diagnostic accuracy of prehospital acquisition of the combination of ECG, point-of-care Troponin T (TnT) testing and transthoracic echocardiography (TTE) by paramedics in identification of NSTEMI. The study ran for just over 2 years and included 253 patients who had called an ambulance with chest pain. In addition to the usual ECG, one ambulance was equipped with TnT testing and a TTE scanner. The TTE results were transferred to an in-hospital cardiologist for review. Paramedics received additional training in TnT testing and TTE scanning.