Pre-hOspital Evaluation of Chest Pain Patients With sUspected Non ST-segment eLevation myocARdial Infarction Using the HEART-score With a Troponin Point-of-care Test

Co-primary Objectives:

1. To evaluate the interobserver agreement of the HEART-score performed by ambulance personnel compared to the HEART-score performed by emergency physicians.
2. To evaluate the diagnostic performance of a strategy based on a pre-hospital HEART-score (with POC cTn testing) or combined with an adjuvant single hs-cTn test at the emergency department to rule-in or rule-out acute coronary syndrome (ACS).
3. To evaluate the diagnostic performance of (serial) POC cTn testing or combined with hs-cTn testing compared to (serial) hs-cTn testing to rule-in or rule-out MI.
4. To investigate the feasibility of using the pre-hospital HEART-score and POC cTn in the 0/1 hour algorithm to rule-out ACS.

Secondary Objectives: 5. To evaluate the occurrence of major adverse cardiac events (MACE) in all included patients with a follow up time of 30 days from first medical contact. 6. To evaluate the patient reported outcome measures (PROMs) in all chest pain patients transported to the hospital at baseline and at 30 days 7. To perform a cost-analysis of an early diagnostic strategy using the pre-hospital HEART-score

Study design: A prospective, observational, single multicentre study Study population: Total number of patients needed for analysis: n=650 Inclusion criteria: - All out-of-hospital chest pain patients visited by an ambulance

• Transportation to a hospital with working diagnosis NSTE-ACS
• Age ≥ 18 years Exclusion criteria: - Comatose state, hemodynamic instability or shock
• Electrocardiographic ST-segment elevation in the pre-hospital setting treated as STEMI
• No pre-hospital 12-lead electrocardiogram performed or available
• An obvious non-cardiac cause for the chest pain (trauma, etc.)
• Suspicion of aortic dissection or pulmonary embolism
• Cognitive impairment
• Pregnancy
• Suspicion of COVID-19 by ambulance