{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:34:51Z","timestamp":1787567691543,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gerencia Regional de Salud de Castilla y Le\u00f3n, Spain","award":["GRS 2967\/B\/2024"],"award-info":[{"award-number":["GRS 2967\/B\/2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Prehospital identification of non-ST-elevation acute coronary syndrome remains unresolved, and available risk scores incorporate troponin categorically. We compared the discriminative performance of cardiac troponin I measured in a blood sample obtained at first prehospital medical contact, analysed as a continuous variable, against the HEART, GRACE, and TIMI scores for predicting 30-day major adverse cardiac events. Methods: We conducted a prospective cohort study in 333 adults with non-traumatic chest pain suggestive of non-ST-elevation acute coronary syndrome, which was attended by two physician-staffed advanced life support units. Venous blood was drawn at first medical contact and analysed later in the laboratory; the results were not available during patient care. All three scores used this same determination as their troponin component. The primary outcome was a composite of all-cause mortality, type 1 myocardial infarction, and unplanned coronary revascularisation at 30 days. Results: The primary outcome occurred in 82 patients (24.6%). Prehospital troponin discriminated better (area under the curve 0.916, 95% CI 0.875\u20130.952) than TIMI (0.817), GRACE (0.767), and HEART (0.721); all comparisons were p &lt; 0.001. An exploratory rule-out threshold of 80 ng\/L identified 61 patients (18.3%) with no events (sensitivity and negative predictive value 100%, exact 95% CI 95.6\u2013100 and 94.1\u2013100), whereas the \u2265780 ng\/L stratum showed an event rate of 69.4%. Conclusions: A blood sample obtained at first prehospital medical contact carries substantial prognostic information that clinical scores discard by categorising it. Because it was analysed subsequently in the laboratory, these findings do not evaluate a real-time strategy; they support development and validation of point-of-care devices.<\/jats:p>","DOI":"10.3390\/diagnostics16172688","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"2688","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Troponin in a Prehospital Blood Sample and Risk Scores"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-1448","authenticated-orcid":false,"given":"Juan F.","family":"Delgado Benito","sequence":"first","affiliation":[{"name":"Prehospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9820-8526","authenticated-orcid":false,"given":"Ana","family":"Ramos-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitario R\u00edo Hortega, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3691-7825","authenticated-orcid":false,"given":"Enrique","family":"Castro-Portillo","sequence":"additional","affiliation":[{"name":"Primary Health Care Unit, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5561-1384","authenticated-orcid":false,"given":"Carlos del Pozo","family":"Vegas","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47007 Valladolid, Spain"},{"name":"Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain"},{"name":"Valladolid Health Research Institute (IBioVALL), 47005 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5092-4138","authenticated-orcid":false,"given":"Ra\u00fal","family":"L\u00f3pez-Izquierdo","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitario R\u00edo Hortega, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"},{"name":"Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain"},{"name":"Valladolid Health Research Institute (IBioVALL), 47005 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco T.","family":"Mart\u00ednez Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Prehospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-7067","authenticated-orcid":false,"given":"Santiago","family":"Otero de la Torre","sequence":"additional","affiliation":[{"name":"Prehospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9910-427X","authenticated-orcid":false,"given":"Miguel \u00c1.","family":"Castro Villamor","sequence":"additional","affiliation":[{"name":"Primary Health Care Unit, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"},{"name":"Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-5108","authenticated-orcid":false,"given":"Ancor","family":"Sanz-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain"},{"name":"Group of Healthcare Assessment, Instituto de Investigaci\u00f3n Sanitaria de Castilla-La Mancha (IDISCAM), 45004 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-2860","authenticated-orcid":false,"given":"Francisco","family":"Mart\u00edn-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Prehospital Critical Care, Emergency Medical Services, Gerencia Regional de Salud de Castilla y Le\u00f3n, 47001 Valladolid, Spain"},{"name":"Faculty of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain"},{"name":"Valladolid Health Research Institute (IBioVALL), 47005 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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