Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study

PROJECT TITLE	PRE-HOSPITAL EVALUATION OF SENSITIVE TROPONIN (PRESTO) STUDY
Funding body	National Institute for Health Research for Patient Benefit (NIHR RFBP) Programme
Total funding	£338,089
Team	Prof Richard Body, University of Manchester and Central Manchester University Hospitals NHS Foundation Trust Dr Mark Hann, University of Manchester Prof A Niroshan Siriwardena, University of Lincoln Duncan Robertson, North West Ambulance Service NHS Trust Alexander Thompson, University of Manchester Andy Rosser, West Midlands Ambulance Service NHS Trust Abdulrhman Alghamdi, University of Manchester Kim Kirby, South West Ambulance Service NHS Trust Dr Edward Carlton, North Bristol NHS Trust Angela Foulkes, Patient Representative Sarah Douglas, Central Manchester University Hospitals NHS Foundation Trust
Team/consortium	University of Manchester Central Manchester University Hospitals NHS Foundation Trust University of Lincoln North West Ambulance Service NHS Trust West Midlands Ambulance Service NHS Trust South West Ambulance Service NHS Trust North Bristol NHS Trust
Overarching aim	Our primary aim is to determine whether paramedics can accurately use a simple algorithm and a near-patient blood test to avoid unnecessarily transporting patients with suspected acute coronary syndromes to hospital Emergency Departments for further tests.
Objectives	Primary objective is to evaluate diagnostic accuracy of the T-MACS decision aid when applied by paramedics in the prehospital setting using portable near-patient (point of care) cardiac troponin tests. Secondary objectives are to evaluate the projected impact of implementing this intervention on the following outcomes: Proportion of patients with and without ACS who could avoid unnecessary transport to hospital Emergency Departments if T-MACS had been used in practice (i.e. further evaluating the ability of T-MACS to ‘rule out’ ACS in the pre-hospital setting) The diagnostic accuracy of T-MACS to ‘rule in’ ACS and potentially enable direct transfer to a tertiary care heart attack centre for specialist treatment (i.e. by identifying patients as ‘high risk’ versus any other risk group) Proportion of patients with and without ACS who would have been transported to a tertiary care heart attack centre for specialist treatment Healthcare costs (from an NHS perspective) and the projected cost savings per quality adjusted life year (QALY)
Methods	Prospective, observational diagnostic accuracy study
Outcomes	The primary outcome will be the diagnosis of ACS, which will be adjudicated by two independent investigators blinded to the assessment of T-MACS by paramedics. Discrepancies will be resolved by a third independent investigator. ACS will be defined as either (a) prevalent acute myocardial infarction (AMI), defined in accordance with the universal definition of AMI; or (b) incident major adverse cardiac events (cardiac death, AMI or non-elective coronary revascularization) within 30 days. Secondary outcomes will include healthcare resource utilisation and health status (EQ-5D).
Outputs	Peer reviewed publications and conference presentations.
Impact	This study will identify a novel means of delivering efficient pre-hospital emergency care to patients with chest pain. With a programme of training and dissemination and based on similar precedents, we aim to achieve clinical implementation within 2 years. This is likely to lead to substantial cost savings for the NHS and safe early reassurance for thousands of patients.

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