An emergency department strategy that uses two biomarkers to triage patients with suspected acute coronary syndrome (ACS) can increase the rate of early, safe hospital discharge, according to results of the Biomarkers in Cardiology 8 (BIC-8) trial.
"This biomarker strategy using a state-of-the-art quantitative troponin assay in combination with an ultrasensitive copeptin assay has the potential to change clinical practice with high patient safety," said lead investigator Martin Möckel, MD, PhD, from Charité - Universitätsmedizin Berlin, in Berlin, Germany.
"This is the first interventional trial to study whether it is safe to discharge suspected ACS patients who test troponin and copeptin negative at admission. Using this strategy, a high proportion of patients could be discharged early, thus unnecessary treatments and resources could be saved, causing a substantial benefit for patients and health care providers."
Emergency departments worldwide face increasing overcrowding and patients with signs and symptoms which might be caused by an acute coronary syndrome are very common, even though only around 15% of these patients are ultimately diagnosed with an acute myocardial infarction as the underlying disease, explained Dr. Möckel.
"Rapid rule-out of acute myocardial infarction (MI) is therefore a major clinical need, saving the health care system time and resources and patients unnecessary stress, anxiety and other risks associated with hospitalization."
Current guidelines recommend that patients receive serial troponin testing to confirm that hospital discharge is appropriate, but this testing delays definitive action, he said.
"The new biomarker copeptin has been shown to be elevated in patients first presenting with acute MI, and when combined with the cardiac troponin biomarker has an excellent negative predictive value for acute MI. However, an early discharge strategy based on combining these two tests has never been assessed prospectively."
BIC-8, a multicentre, open, randomized, controlled clinical trial included 902 patients with an initial negative troponin test to assess this strategy.
In the experimental arm (n=451), patients with a negative copeptin test (less than 10 pmol/L) were discharged into ambulant care, with a scheduled outpatient visit within 72 hours, while those with a positive copeptin test received standard treatment according to current guidelines.
Among patients in the standard arm (n=451), copeptin results were not available to treating staff and patients were treated according to current guidelines.
At 30 days of follow-up the rate of major adverse cardiovascular events (MACE) was similar in both groups (5.46% in the experimental arm vs 5.5% in the standard arm), but emergency room discharge rates were significantly higher in the experimental arm (66% vs 12%; P < 0.001).
The results support the consideration of a new treatment algorithm in low-to-intermediate risk patients with suspected ACS, said Dr. Möckel.
"Patients with a negative troponin and a negative copeptin result at admission can safely be discharged if the final clinical assessment is consistent with this decision, as long as a timely diagnostic work-up is done in the outpatient setting," he said.
However, the clinical judgment of the treating physician is of utmost importance, he stressed.
"If his or her final clinical assessment excludes discharge due to high suspicion of ACS, perhaps due to recurrent symptoms or an updated history, the patient should not be discharged despite negative biomarker results."
SOURCES OF FUNDING : This investigator initiated trial was funded by a research grant of B.R.A.H.M.S GmbH a ThermoFisher company
DISCLOSURES: MM, JS and AS received research grants from Thermo Scientific BRAHMS, Radiometer, Siemens and Abbott; MM received lecture and consultancy honoraria from Bayer, Astra Zeneca and The Medicines Company; CH has received speaker honoraria and is member of the advisory board for Thermo Scientific BRAHMS; SB has received research funding from Abbott, Abbott Diagnostics, Bayer, Boehringer Ingelheim, Siemens and Thermo Fisher. He received honoraria for lectures from Abbott, Abbott Diagnostics, Astra Zeneca, Bayer, Boehringer Ingelheim, Medtronic, Pfizer, Roche, Siemens Diagnostics, Siemens, Thermo Fisher and as a member of Advisory Boards and for consulting for Boehringer Ingelheim, Bayer, Novartis, Roche and Thermo Fisher; KH has no conflict of interests to declare; CM has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, Abbott, Alere, BRAHMS, Nanosphere, Roche, Siemens, 8sense, Critical Diagnostics, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria and consultancy fees from Abbott, Alere, BG Medicine, BRAHMS, Novartis, Roche, and Siemens; JOV is employed at Thermo Fisher, Brahms GmbH in Henningsdorf, Germany as a medical director; EG has received honoraria for lectures from Roche Diagnostics, he received honoraria for lectures and consultancy fees from BRAHMS GmbH.
NOTE TO EDITORS
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2013
The ESC Congress is currently the world's premier conference on the science, management and prevention of cardiovascular disease. The spotlight of this year's event is "The Heart Interacting with Systemic Organs". ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information is available from the ESC Press Office at firstname.lastname@example.org
ESC Press Office | Source: EurekAlert!
Further information: www.escardio.org
Further Reports about: ACS > acute coronary syndrome > acute myocardial infarction > algorithm > BIC-8 > Biomarker > Brahms > Cardiology > cardiovascular disease > coronary syndrome > Diagnostic > ESC > health care > hospital discharge > Ingelheim > myocardial infarction > research grant > Thermo > vascular disease
More articles from Health and Medicine:
Human Stem Cells Predict Efficacy of Alzheimer Drugs
06.12.2013 | Rheinische Friedrich-Wilhelms-Universität Bonn
Recurring memory traces boost long-lasting memories
05.12.2013 | Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)
International team of scientists develops new feedback method for optimizing the laser pulse shapes used in the control of chemical reactions
In many ways, traditional chemical synthesis is similar to cooking. To alter the final product, you can change the ingredients or their ratio, change the method of mixing ingredients, or change the temperature or pressure of the environment of the ingredients.
Like an accomplished chef, chemists have become very skilled ...
A genetic defect protects mice from infection with influenza viruses
A new study published in the scientific journal PLOS Pathogens points out that mice lacking a protein called Tmprss2 are no longer affected by certain flu viruses.
The discovery was made by researchers from the Helmholtz Centre for Infection Research (HZI) in Braunschweig in collaboration with colleagues from Göttingen and ...
The Light: Global study gets underway with online user survey
Light has a fundamental impact on our sense of well-being and performance. In cooperation with Zumtobel, a supplier of lighting solutions, Fraunhofer IAO has launched a global user survey of lighting quality in offices. The objective is to identify the best lighting conditions for a variety of spaces and lighting ...
Quantum entanglement, a perplexing phenomenon of quantum mechanics that Albert Einstein once referred to as “spooky action at a distance,” could be even spookier than Einstein perceived.
Physicists at the University of Washington and Stony Brook University in New York believe the phenomenon might be intrinsically linked with wormholes, hypothetical features of space-time that in popular science fiction can provide a much-faster-than-light shortcut from one part of the universe to another.
But here’s the catch: One couldn’t actually ...
A star is formed when a large cloud of gas and dust condenses and eventually becomes so dense that it collapses into a ball of gas, where the pressure heats the matter, creating a glowing gas ball – a star is born.
New research from the Niels Bohr Institute, among others, shows that a young, newly formed star in the Milky Way had such an explosive growth, that it was initially about 100 times brighter than it is now. The results are published in the scientific journal, Astrophysical Journal Letters.
The young ...
06.12.2013 | Materials Sciences
06.12.2013 | Life Sciences
06.12.2013 | Life Sciences
05.12.2013 | Event News
04.12.2013 | Event News
12.11.2013 | Event News