Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study
Standard
Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. / Möckel, Martin; Searle, Julia; Hamm, Christian; Slagman, Anna; Blankenberg, Stefan; Huber, Kurt; Katus, Hugo; Liebetrau, Christoph; Müller, Christian; Muller, Reinhold; Peitsmeyer, Philipp; von Recum, Johannes; Tajsic, Milos; Vollert, Jörn O; Giannitsis, Evangelos.
in: EUR HEART J, Jahrgang 36, Nr. 6, 07.02.2015, S. 369-376.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study
AU - Möckel, Martin
AU - Searle, Julia
AU - Hamm, Christian
AU - Slagman, Anna
AU - Blankenberg, Stefan
AU - Huber, Kurt
AU - Katus, Hugo
AU - Liebetrau, Christoph
AU - Müller, Christian
AU - Muller, Reinhold
AU - Peitsmeyer, Philipp
AU - von Recum, Johannes
AU - Tajsic, Milos
AU - Vollert, Jörn O
AU - Giannitsis, Evangelos
N1 - © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2015/2/7
Y1 - 2015/2/7
N2 - 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.
AB - 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.
KW - Acute Coronary Syndrome/diagnosis
KW - Arrhythmias, Cardiac
KW - Biomarkers/metabolism
KW - Coronary Artery Bypass
KW - Death, Sudden, Cardiac/etiology
KW - Early Diagnosis
KW - Female
KW - Glycopeptides/metabolism
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/etiology
KW - Patient Discharge
KW - Patient Readmission
KW - Percutaneous Coronary Intervention
KW - Treatment Outcome
KW - Troponin T/metabolism
U2 - 10.1093/eurheartj/ehu178
DO - 10.1093/eurheartj/ehu178
M3 - SCORING: Journal article
C2 - 24786301
VL - 36
SP - 369
EP - 376
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 6
ER -