Mehrshad Vafaie1, Anna Slagman2, Martin Möckel2, Christian Hamm3, Kurt Huber4, Christian Müller5, Jörn O Vollert6, Stefan Blankenberg7, Hugo A Katus1, Christoph Liebetrau8, Evangelos Giannitsis1, Julia Searle9. 1. Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany. 2. Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany. 3. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany; Medical Clinic I, Cardiology and Angiology, University of Giessen, Giessen, Germany. 4. Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria. 5. Department of Cardiology, University Hospital Basel, Switzerland. 6. Clinical Diagnostics, Thermo Fisher Scientific, B.R.A.H.M.S GmbH, Hennigsdorf, Germany. 7. Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany. 8. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. 9. Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany. Electronic address: Julia.searle@charite.de.
Abstract
BACKGROUND: The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department. METHODS:Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission. RESULTS: Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536). CONCLUSIONS: In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
RCT Entities:
BACKGROUND: The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department. METHODS:Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission. RESULTS: Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536). CONCLUSIONS: In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
Authors: Evangelos Giannitsis; Piers Clifford; Anna Slagman; Ralph Ruedelstein; Christoph Liebetrau; Christian Hamm; Didier Honnart; Kurt Huber; Jörn Ole Vollert; Carlo Simonelli; Malte Schröder; Jan C Wiemer; Matthias Mueller-Hennessen; Hinrich Schroer; Kim Kastner; Martin Möckel Journal: BMJ Open Date: 2019-07-23 Impact factor: 2.692
Authors: James E Andruchow; Timothy Boyne; Grant Innes; Shabnam Vatanpour; Isolde Seiden-Long; Dongmei Wang; Eddy Lang; Andrew D McRae Journal: CJC Open Date: 2019-08-27
Authors: Evangelos Giannitsis; Stefan Blankenberg; Robert H Christenson; Norbert Frey; Stephan von Haehling; Christian W Hamm; Kenji Inoue; Hugo A Katus; Chien-Chang Lee; James McCord; Martin Möckel; Jack Tan Wei Chieh; Marco Tubaro; Kai C Wollert; Kurt Huber Journal: Clin Res Cardiol Date: 2021-02-26 Impact factor: 5.460