Interest of CARE Rule to Exclude the Hypothesis of an Acute Coronary Syndrome Without Bioassay - ICARE
- Conditions
- Chest Pain
- Interventions
- Other: CARE Rule
- Registration Number
- NCT02813499
- Lead Sponsor
- University Hospital, Angers
- Brief Summary
Acute coronary syndrome (ACS) is a major health problem and its diagnosis remains a challenge for the emergency physician. The management of a suspected ACS is well codified, based on troponin assays, renewed if necessary.
Conversely, the criteria leading to initiate a diagnostic procedure in chest pain to the Emergency department are unclear. The fear is, firstly, to miss a potentially life treating diagnosis and, secondly, exposing many patients to unnecessary examinations. The advent of highly sensitive troponin assays also increases the risk of over-investigation by a larger number of elevations of the biomarker in non-coronary circumstances leading to a prolongation of hospitalization and, possibly, unnecessary treatments and invasive investigations.
CARE rule could help to streamline this first step. It is established by assigning a value from 0 to 2 to the items: Characteristic of pain, Age, Risk factors and ECG. The search for an ACS is not justified if the sum of points is ≤1 (negative rule) and, conversely, a troponin should be performed if the sum is \> 1 (positive rule).
Indeed, CARE rule corresponds to the first 4 items of the HEART score (the latter standing for troponin at admission) whose reliability has been demonstrated, a ≤3 income excluding ACS with a risk of false negatives \<2%. A negative CARE rule always corresponds to a HEART score ≤3.
Our study aims to confirm the interest of CARE rule to streamline the search for an ACS in chest pain as an observational European multicenter prospective study.
- Detailed Description
CARE rule was evaluated in a prospective study of routine care on 641 patients among which 9.8% had a Major Adverse Cardiac Event (MACE). 200 patients (31%) had a negative rule and none showed MACE during the 45-day follow-up (0% \[0-1.9\]). Among these 200 patients, 119 had a standard troponin assay, a single dosage was increased.
The main objective is to demonstrate the reliability of CARE rule to exclude ACS in chest pain, using an observational Franco-Belgian multicenter study in routine care.
If the reliability of CARE rule is confirmed in Emergency departments, it could be evaluated to be used in other circumstances such as in pre-hospital or in private practice for the general practitioner or cardiologist.
In summary, the ICARE study is intended to allow a rationalization of the management of patients with chest pain, limiting the use of unnecessary investigations while ensuring the safety of care.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1453
- patient admitted to the emergency department or chest pain
- patient admitted in a non-scheduled manner
- non-traumatic chest pain
- no formal diagnosis after frontline examinations
- patient with an ECG showing a coronary syndrome ST +
- patient for which a 6-weeks follow-up would be impossible
- patient refusing to participate
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description CARE Rule CARE Rule Evaluation of the clinical suspicion of myocardial infarction and calculation of CARE rule.
- Primary Outcome Measures
Name Time Method The failure rate of the diagnostic strategy will be evaluated by the rate of MACE recorded in the course of the phone call follow-up at 45 days of patient's inclusion in the group of patients with negative CARE rule. Day 45 This rate is a composite criterion including myocardial infarction, percutaneaous coronary intervention, coronary artery bypass grafting or sudden death for which a cardiac cause cannot be excluded. The procedure will be considered acceptable if the rate of false negatives among patients with negative CARE rule is less than 1% with an upper limit of the 95% confidence interval lower than 3%.
- Secondary Outcome Measures
Name Time Method Number of bioassay which could be saved, measured by the difference between the number of bioassays actually made least the number bioassays requested by the strategy Day 45 Difference between average times of consultation according to the need for a bioassay based on CARE rule Day 45 The failure rate of the HEART score only considering only one dosage of troponin at admission assessed by the proportion of MACE at 45 days in the HEART group ≤3 Day 45
Trial Locations
- Locations (6)
Cliniques Universitaires Saint-Luc
🇧🇪Brussels, Belgium
University Hospital Angers
🇫🇷Angers, France
Hospital of Cholet
🇫🇷Cholet, France
SCHOTTE Thibault
🇫🇷Le Mans, France
Hospital of Saint-Malo
🇫🇷Saint Malo, France
University Hospital Toulouse
🇫🇷Toulouse, France
Cliniques Universitaires Saint-Luc🇧🇪Brussels, Belgium