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Eur Heart J. 2015 Feb 7;36(6):369-76. doi: 10.1093/eurheartj/ehu178. Epub 2014 Apr 30.

Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study.

Author information

1
Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany martin.moeckel@charite.de.
2
Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
3
Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany Medical Clinic I, University Hospital Gießen, Gießen, Germany.
4
Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.
5
Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria.
6
Department of Angiology, Cardiology and Pneumology, University Hospital Heidelberg, Germany.
7
Department of Cardiology, Universitätsspital Basel, Switzerland.
8
School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia.
9
Thermo Fisher Scientific, Clinical Diagnostics, B·R·A·H·M·S GmbH, Hennigsdorf, Germany.

Abstract

AIMS:

This randomized controlled trial (RCT) evaluated whether a process with single combined testing of copeptin and troponin at admission in patients with low-to-intermediate risk and suspected acute coronary syndrome (ACS) does not lead to a higher proportion of major adverse cardiac events (MACE) than the current standard process (non-inferiority design).

METHODS AND RESULTS:

A total of 902 patients were randomly assigned to either standard care or the copeptin group where patients with negative troponin and copeptin values at admission were eligible for discharge after final clinical assessment. The proportion of MACE (death, survived sudden cardiac death, acute myocardial infarction (AMI), re-hospitalization for ACS, acute unplanned percutaneous coronary intervention, coronary artery bypass grafting, or documented life threatening arrhythmias) was assessed after 30 days. Intention to treat analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI) 3.30-7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32-7.69%; 23/443) in the copeptin group. In the per protocol analysis, the MACE proportion was 5.34% (95% CI 3.38-7.97%) in the standard group, and 3.01% (95% CI 1.51-5.33%) in the copeptin group. These results were also corroborated by sensitivity analyses. In the copeptin group, discharged copeptin negative patients had an event rate of 0.6% (2/362).

CONCLUSION:

After clinical work-up and single combined testing of troponin and copeptin to rule-out AMI, early discharge of low- to intermediate risk patients with suspected ACS seems to be safe and has the potential to shorten length of stay in the ED. However, our results need to be confirmed in larger clinical trials or registries, before a clinical directive can be propagated.

KEYWORDS:

Acute coronary syndrome (ACS); Acute myocardial infarction (AMI); Copeptin; Randomized controlled trial (RCT); Rule-out

PMID:
24786301
PMCID:
PMC4320319
DOI:
10.1093/eurheartj/ehu178
[Indexed for MEDLINE]
Free PMC Article

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