Chest Pain Clinical Trial
Official title:
Intérêt de la règle CARE Pour Exclure l'hypothèse d'un Syndrome Coronarien Aigu Sans Dosage Biologique - ICARE
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.
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.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT04153006 -
Comparison of Fingerstick Versus Venous Sample for Troponin I.
|
||
| Recruiting |
NCT03664973 -
Serratus Plane Block for Rib Fractures
|
N/A | |
| Completed |
NCT02905383 -
The Effect of Exercise on Physical Function and Health in Older People After Discharge From Hospital
|
N/A | |
| Not yet recruiting |
NCT05649891 -
Checklists Resuscitation Emergency Department
|
N/A | |
| Withdrawn |
NCT03906812 -
A Randomized Trial of Telemetry Compared With Unmonitored Floor Admissions in ED Patients With Low-Risk Chest Pain
|
N/A | |
| Active, not recruiting |
NCT02892903 -
In the Management of Coronary Artery Disease, Does Routine Pressure Wire Assessment at the Time of Coronary Angiography Affect Management Strategy, Hospital Costs and Outcomes?
|
N/A | |
| Completed |
NCT02538861 -
Acute Chest Pain Imaging in the ED With the Combine CCTA and CT Perfusion
|
||
| Completed |
NCT02538770 -
Rapid Viral Diagnostics in Adults to Reduce Antimicrobial Consumption and Duration of Hospitalization
|
N/A | |
| Completed |
NCT02440893 -
Understanding the Effect of Metformin on Corus CAD (or ASGES)
|
||
| Completed |
NCT01931852 -
Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin
|
N/A | |
| Completed |
NCT01665521 -
Efficacy Evaluation of the HEART Pathway in Emergency Department Patients With Acute Chest Pain
|
N/A | |
| Recruiting |
NCT01542086 -
Comparison of the Cost-Effectiveness of Coronary CT Angiography Versus Myocardial SPECT in Patients With Intermediate Risk of Coronary Heart Disease
|
N/A | |
| Completed |
NCT01604655 -
ProspEctive First Evaluation in Chest Pain Trial
|
N/A | |
| Terminated |
NCT01836211 -
High-Sensitivity Troponin T and Coronary Computed Tomography Angiography for Rapid Diagnosis of Emergency Chest Pain
|
N/A | |
| Completed |
NCT01486030 -
Effect of Exercise Stress Testing on Peripheral Gene Expression Using Corus CAD (or ASGES) Diagnostic Test
|
||
| Completed |
NCT01163019 -
2D Strain Echocardiography for Diagnosing Chest Pain in the Emergency Room
|
N/A | |
| Completed |
NCT00709670 -
ComParative Diagnostic Study Between Multislice Computed Tomography (MSCT) and Stress Echography in Coronarin Patients.
|
N/A | |
| Completed |
NCT00536224 -
Chest Pain Observation Unit Risk Reduction Trial
|
N/A | |
| Terminated |
NCT00221182 -
Stem Cell Study for Patients With Heart Disease
|
Phase 1/Phase 2 | |
| Completed |
NCT00075088 -
Tele-Electrocardiography in Emergency Cardiac Care
|
Phase 3 |