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A randomised controlled trial of point-of-care cardiac markers in the emergency department
DOI 10.1186/ISRCTN37823923
ClinicalTrials.gov identifier
EudraCT number
Public title A randomised controlled trial of point-of-care cardiac markers in the emergency department
Scientific title
Acronym RATPAC (Randomised Assessment of Treatment using Panel Assay of Cardiac markers)
Serial number at source HTA 06/302/19
Study hypothesis To evaluate the clinical effectiveness and cost-effectiveness of the most promising point-of-care cardiac marker panel currently used in the Emergency Department.

Please note that, as of 11/05/2009, the anticipated end date of this trial has been updated from 31/03/2009 to 30/09/2009.
Lay summary Not provided at time of registration
Ethics approval Ethics approval received from the Leeds East Research Ethics Committee on the 27th March 2007 (ref: 07/Q1206/22).
Study design A pragmatic randomised controlled trial
Countries of recruitment United Kingdom
Disease/condition/study domain Chest pain due to suspected but not proven AMI
Participants - inclusion criteria People presenting to the Emergency Department with chest pain due to suspected but not proven Acute Myocardial Infarction (AMI) in whom a negative point-of-care marker test could potentially rule out AMI and allow discharge home.
Participants - exclusion criteria 1. Patients with diagnostic Electrocardiogram (ECG) changes for AMI or high-risk acute coronary syndrome (more than 1 mm ST deviation or more than 3 mm inverted T waves). These patients are at high risk of adverse outcome and require inpatient care even if marker tests are negative
2. Patients with known coronary heart disease presenting with prolonged (more than one hour) or recurrent episodes of typical cardiac-type pain. These patients have unstable angina and require inpatient care for symptom control even if marker tests are negative
3. Patients with proven or suspected serious non-coronary pathology (e.g. pulmonary embolus) that requires inpatient care even if AMI is ruled out
4. Patients with co-morbidity or social problems that require hospital admission even if AMI can be ruled out
5. Patients with an obvious non-cardiac cause (e.g. pneumothorax or muscular pain), in whom AMI can be excluded as a possible cause without resorting to further diagnostic testing
6. Patients presenting more than 12 hours after their most significant episode of pain, for whom a single troponin measurement would clearly be more appropriate than point-of-care panel testing
7. Previous participants in the RATPAC trial
8. Patients who are unable to understand the trial information due to cognitive impairment
9. Non-English speaking patients for whom translation facilities are not available
Anticipated start date 01/04/2007
Anticipated end date 30/09/2009
Status of trial Completed
Patient information material Patient information sheet can be found at: http://www.shef.ac.uk/content/1/c6/06/76/17/Patient%20information%20sheet.pdf
Target number of participants 3130
Interventions This is a pragmatic randomised controlled trial and economic evaluation of a point-of-care cardiac marker panel in the management of patients with suspected, but not proven, Acute Myocardial Infarction (AMI) in six Emergency Departments in the United Kingdom. Emergency Department staff will identify eligible patients, provide trial information and obtain written consent.

Participants will be randomised to receive either:
1. Diagnostic assessment using the point-of-care biochemical marker panel, or
2. Conventional diagnostic assessment without the panel.

The only difference between the two arms of the trial will be that patients in the intervention arm will receive testing with the point-of-care panel. The use of all other tests and treatments, and decision-making in the Emergency Department, will be at the discretion of the attending clinician.

The point-of-care cardiac marker panel will comprise Creatine Kinase - Myocardial Bands (CK-MB) (mass), myoglobin and troponin I, measured at presentation and 90 minutes later, using the Biosite Triage cardiac marker panel. This combination has been widely evaluated in practice. An independent evaluation by the Centre for Evidence-based Purchasing found that the Biosite system was reliable and easy to use, and that the ability of the point-of-care method to detect a positive troponin was similar to that of laboratory methods.
Primary outcome measure(s) Proportion of patients successfully discharged home after Emergency Department assessment, defined as discharge with no adverse event (defined in next section) during the following three months.
Secondary outcome measure(s) 1. Health utility measured using the Euro Quality of life (EQ-5D) self-complete questionnaire at one and three months after attendance
2. Satisfaction with care measured at one month after attendance using a modified Group Health Association of America questionnaire that has been used successfully in previous studies of diagnostic strategies for acute chest pain
3. The proportion of patients managed on the coronary care unit, receiving cardiac medications (such as heparin, clopidogrel or glycoprotein IIb/IIIa inhibitors) or receiving cardiac interventions (such as angiography, percutaneous intervention or bypass grafting)
4. Re-attendance at and/or re-admission to hospital over the following three months
5. Adverse events (death, non-fatal AMI, emergency revascularisation or hospitalisation for myocardial ischaemia)
6. The proportion of admitted patients ultimately diagnosed as having AMI by European Society of Cardiology (ESC)/American College of Cardiology (ACC) criteria
Sources of funding NIHR Health Technology Assessment Programme - HTA (UK)
Trial website http://www.shef.ac.uk/chestpain/
Publications 1. 2011 results in http://www.ncbi.nlm.nih.gov/pubmed/20884788
2. 2011 results in http://www.ncbi.nlm.nih.gov/pubmed/21616014
3. 2013 results in http://www.ncbi.nlm.nih.gov/pubmed/23597479
Contact name Prof  Steve  Goodacre
  Address Medical Care Research Unit
University of Sheffield
Regent Court
30 Regent Street
  City/town Sheffield
  Zip/Postcode S1 4DA
  Country United Kingdom
  Tel +44 (0)114 222 0750
  Fax +44 (0)114 222 0749
  Email s.goodacre@sheffield.ac.uk
Sponsor University of Sheffield (UK)
  Address Research Services Department
New Spring House
231 Glossop Road
  City/town Sheffield
  Zip/Postcode S10 2GW
  Country United Kingdom
  Tel +44 (0)114 222 1448
  Email R.J.Hudson@sheffield.ac.uk
  Sponsor website: http://www.shef.ac.uk/
Date applied 31/01/2007
Last edited 06/01/2014
Date ISRCTN assigned 01/02/2007
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