Multicentre cross-sectional observational registry to monitor the safety of early discharge after rule-out of acute myocardial infarction by copeptin and troponin

• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Verfasst von: Clifford, Piers [VerfasserIn]
• Verfasst von: Slagman, Anna [VerfasserIn]
• Verfasst von: Rüdelstein, Ralph [VerfasserIn]
• Verfasst von: Liebetrau, Christoph [VerfasserIn]
• Verfasst von: Hamm, Christian [VerfasserIn]
• Verfasst von: Honnart, Didier [VerfasserIn]
• Verfasst von: Huber, Kurt [VerfasserIn]
• Verfasst von: Vollert, Jörn Ole [VerfasserIn]
• Verfasst von: Simonelli, Carlo [VerfasserIn]
• Verfasst von: Schröder, Malte [VerfasserIn]
• Verfasst von: Wiemer, Jan C. [VerfasserIn]
• Verfasst von: Müller-Hennessen, Matthias [VerfasserIn]
• Verfasst von: Schroer, Hinrich [VerfasserIn]
• Verfasst von: Kastner, Kim [VerfasserIn]
• Verfasst von: Möckel, Martin [VerfasserIn]
• Titel: Multicentre cross-sectional observational registry to monitor the safety of early discharge after rule-out of acute myocardial infarction by copeptin and troponin
• Titelzusatz: the Pro-Core registry
• Verf.angabe: 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
• Jahr: 2019
• Umfang: 11 S.
• Fussnoten: Gesehen am 19.03.2020
• Titel Quelle: Enthalten in: BMJ open
• Ort Quelle: London : BMJ Publishing Group, 2011
• Jahr Quelle: 2019
• Band/Heft Quelle: 9(2019,7) Artikel-Nummer e028311, 11 Seiten
• ISSN Quelle: 2044-6055
• DOI: doi:10.1136/bmjopen-2018-028311
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute coronary syndrome
• Sach-SW: copeptin
• Sach-SW: mortality
• Sach-SW: myocardial infarction
• Sach-SW: registry
• Sach-SW: troponin
• K10plus-PPN: 1692986104

Abstract

Objectives There is sparse information on the safety of early primary discharge from the emergency department (ED) after rule-out of myocardial infarction in suspected acute coronary syndrome (ACS). This prospective registry aimed to confirm randomised study results in patients at low-to-intermediate risk, with a broader spectrum of symptoms, across different institutional standards and with a range of local troponin assays including high-sensitivity cTn (hs-cTn), cardiac troponin (cTn) and point-of-care troponin (POC Tn). - Design Prospective, multicentre European registry. - Setting 18 emergency departments in nine European countries (Germany, Austria, Switzerland, France, Spain, UK, Turkey, Lithuania and Hungary) - Participants The final study cohort consisted of 2294 patients (57.2% males, median age 57 years) with suspected ACS. - Interventions Using the new dual markers strategy, 1477 patients were eligible for direct discharge, which was realised in 974 (42.5%) of patients. - Main outcome measures The primary endpoint was all-cause mortality at 30 days. - Results Compared with conventional workup after dual marker measurement, the median length of ED stay was 60 min shorter (228 min, 95% CI: 219 to 239 min vs 288 min, 95% CI: 279 to 300 min) in the primary dual marker strategy (DMS) discharge group. All-cause mortality was 0.1% (95% CI: 0% to 0.6%) in the primary DMS discharge group versus 1.1% (95% CI: 0.6% to 1.8%) in the conventional workup group after dual marker measurement. Conventional workup instead of discharge despite negative DMS biomarkers was observed in 503 patients (21.9%) and associated with higher prevalence of ACS (17.1% vs 0.9%, p<0.001), cardiac diagnoses (55.2% vs 23.5%, p<0.001) and risk factors (p<0.01), but with a similar all-cause mortality of 0.2% (95% CI: 0% to 1.1%) versus primary DMS discharge (p=0.64). - Conclusions Copeptin on top of cardiac troponin supports safe discharge in patients with chest pain or other symptoms suggestive of ACS under routine conditions with the use of a broad spectrum of local standard POC, conventional and high-sensitivity troponin assays. - Trial registration number NCT02490969.