Acute Rule out of non ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART score assessment and a single poInt of CAre troponin
ARTICA-1 is a multicenter randomized study conducted between 2019 and 2024 by Joris Aarts and Cyril Camaro. The study focused on the pre-hospital triage of patients with chest pain and a low risk of myocardial infarction.
The then-current standard of care, in which patients were transported by ambulance to the Cardiac Emergency Unit (CEU) for further examination, was compared with a new method. With this new method, the course of action was determined based on the modified HEAR(T) score in combination with a troponin measurement in the ambulance. Patients with a low risk profile and a low troponin level could safely remain at home. If the troponin level was elevated, the patient was transported by ambulance to the CEU of the nearest hospital (see the flowchart below).
ARTICA-1 demonstrated that this new approach is safe and leads to significant savings in healthcare costs. Partly as a result of these findings, standard care for patients with a low risk of myocardial infarction in the Netherlands has been adjusted as of January 1, 2026. More information about the results of ARTICA-1 can be found under the ‘Publications’ tab.
However, approximately two-thirds of patients with chest pain have an average to high risk of myocardial infarction. For this group, it is not yet clear whether pre-hospital triage can be further improved. Therefore, we are focusing on these patients in ARTICA-2.
