Cargando…

Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial

Regarding the management of suspected Non-ST-segment-elevation acute coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8 randomized controlled trial study had reported non-inferiority for the incidence of major adverse cardiac events at 30 days in the Copeptin group (dual marker strate...

Descripción completa

Detalles Bibliográficos
Autores principales: Giannitsis, Evangelos, Garfias-Veitl, Tania, Slagman, Anna, Searle, Julia, Müller, Christian, Blankenberg, Stefan, von Haehling, Stephan, Katus, Hugo A., Hamm, Christian W., Huber, Kurt, Vollert, Jörn O., Möckel, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773592/
https://www.ncbi.nlm.nih.gov/pubmed/35053326
http://dx.doi.org/10.3390/cells11020211
_version_ 1784636130693480448
author Giannitsis, Evangelos
Garfias-Veitl, Tania
Slagman, Anna
Searle, Julia
Müller, Christian
Blankenberg, Stefan
von Haehling, Stephan
Katus, Hugo A.
Hamm, Christian W.
Huber, Kurt
Vollert, Jörn O.
Möckel, Martin
author_facet Giannitsis, Evangelos
Garfias-Veitl, Tania
Slagman, Anna
Searle, Julia
Müller, Christian
Blankenberg, Stefan
von Haehling, Stephan
Katus, Hugo A.
Hamm, Christian W.
Huber, Kurt
Vollert, Jörn O.
Möckel, Martin
author_sort Giannitsis, Evangelos
collection PubMed
description Regarding the management of suspected Non-ST-segment-elevation acute coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8 randomized controlled trial study had reported non-inferiority for the incidence of major adverse cardiac events at 30 days in the Copeptin group (dual marker strategy of copeptin and hs-cTnT at presentation) compared to the standard process (serial hs-cTnT testing). However, in 349 (38.7%) of the 902 patients, high-sensitivity cardiac troponin was not available for the treating physicians. High sensitivity cardiac troponin T was re-measured from thawed blood samples collected at baseline. This cohort qualified for a re-analysis of the 30-day incidence rate of MACE (death, survived cardiac death, acute myocardial infarction, re-hospitalization for acute coronary syndrome, acute unplanned percutaneous coronary intervention, coronary bypass grafting, or documented life-threatening arrhythmias), or components of the primary endpoint including death or death/MI. After re-measurement of troponin and exclusion of 9 patients with insufficient blood sample volume, 893 patients qualified for re-analysis. A total of 57 cases were detected with high sensitivity cardiac troponin T ≥ 14 ng/L who had been classified as “troponin negative” based on a conventional cardiac troponin T or I < 99th percentile upper limit of normal. Major adverse cardiac events rates after exclusion were non-inferior in the Copeptin group compared to the standard group (4.34% (95% confidence intervals 2.60–6.78%) vs. 4.27% (2.55–6.66%)). Rates were 53% lower in the per-protocol analysis (HR 0.47, 95% CI: 0.18–1.15, p = 0.09). No deaths occurred within 30 days in the discharged low risk patients of the Copeptin group. Copeptin combined with high sensitivity cardiac troponin is useful for risk stratification and allows early discharge of low-to-intermediate risk patients with suspected acute coronary syndrome is as safe as a re-testing strategy at 3 h or later.
format Online
Article
Text
id pubmed-8773592
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-87735922022-01-21 Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial Giannitsis, Evangelos Garfias-Veitl, Tania Slagman, Anna Searle, Julia Müller, Christian Blankenberg, Stefan von Haehling, Stephan Katus, Hugo A. Hamm, Christian W. Huber, Kurt Vollert, Jörn O. Möckel, Martin Cells Article Regarding the management of suspected Non-ST-segment-elevation acute coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8 randomized controlled trial study had reported non-inferiority for the incidence of major adverse cardiac events at 30 days in the Copeptin group (dual marker strategy of copeptin and hs-cTnT at presentation) compared to the standard process (serial hs-cTnT testing). However, in 349 (38.7%) of the 902 patients, high-sensitivity cardiac troponin was not available for the treating physicians. High sensitivity cardiac troponin T was re-measured from thawed blood samples collected at baseline. This cohort qualified for a re-analysis of the 30-day incidence rate of MACE (death, survived cardiac death, acute myocardial infarction, re-hospitalization for acute coronary syndrome, acute unplanned percutaneous coronary intervention, coronary bypass grafting, or documented life-threatening arrhythmias), or components of the primary endpoint including death or death/MI. After re-measurement of troponin and exclusion of 9 patients with insufficient blood sample volume, 893 patients qualified for re-analysis. A total of 57 cases were detected with high sensitivity cardiac troponin T ≥ 14 ng/L who had been classified as “troponin negative” based on a conventional cardiac troponin T or I < 99th percentile upper limit of normal. Major adverse cardiac events rates after exclusion were non-inferior in the Copeptin group compared to the standard group (4.34% (95% confidence intervals 2.60–6.78%) vs. 4.27% (2.55–6.66%)). Rates were 53% lower in the per-protocol analysis (HR 0.47, 95% CI: 0.18–1.15, p = 0.09). No deaths occurred within 30 days in the discharged low risk patients of the Copeptin group. Copeptin combined with high sensitivity cardiac troponin is useful for risk stratification and allows early discharge of low-to-intermediate risk patients with suspected acute coronary syndrome is as safe as a re-testing strategy at 3 h or later. MDPI 2022-01-08 /pmc/articles/PMC8773592/ /pubmed/35053326 http://dx.doi.org/10.3390/cells11020211 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Giannitsis, Evangelos
Garfias-Veitl, Tania
Slagman, Anna
Searle, Julia
Müller, Christian
Blankenberg, Stefan
von Haehling, Stephan
Katus, Hugo A.
Hamm, Christian W.
Huber, Kurt
Vollert, Jörn O.
Möckel, Martin
Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title_full Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title_fullStr Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title_full_unstemmed Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title_short Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial
title_sort biomarkers-in-cardiology 8 re-visited—consistent safety of early discharge with a dual marker strategy combining a normal hs-ctnt with a normal copeptin in low-to-intermediate risk patients with suspected acute coronary syndrome—a secondary analysis of the randomized biomarkers-in-cardiology 8 trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773592/
https://www.ncbi.nlm.nih.gov/pubmed/35053326
http://dx.doi.org/10.3390/cells11020211
work_keys_str_mv AT giannitsisevangelos biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT garfiasveitltania biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT slagmananna biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT searlejulia biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT mullerchristian biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT blankenbergstefan biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT vonhaehlingstephan biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT katushugoa biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT hammchristianw biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT huberkurt biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT vollertjorno biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial
AT mockelmartin biomarkersincardiology8revisitedconsistentsafetyofearlydischargewithadualmarkerstrategycombininganormalhsctntwithanormalcopeptininlowtointermediateriskpatientswithsuspectedacutecoronarysyndromeasecondaryanalysisoftherandomizedbiomarkersincardiology8trial