van Dongen DN, et al. - In this prospective cohort study, researchers assessed the added value of the troponin component to the pre-hospital HEART score in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Paramedics performed pre-hospital risk stratification using the HEART score in 700 patients with suspected NSTE-ACS, with major adverse cardiac events (MACE) within 45 days after inclusion as the primary endpoint. The definition of low risk was HEAR or HEART score ≤ 3. They found that, among the low-risk group, 13 patients (7%) experienced MACE when HEAR was used and 5 patients had MACE when HEART was used. They also noted that a higher predictive value was obtained with the use of HEART (Area under the curve [AUC] 0.74) vs HEAR (AUC 0.65, p < 0.001) for MACE. Overall, they concluded that, the pre-hospital troponin component of the HEART score has important added predictive value in this patient population.