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
Evangelos Giannitsis,
Tania Garfias-Veitl,
Anna Slagman,
Julia Searle,
Christian Müller,
Stefan Blankenberg,
Stephan von Haehling,
Hugo A. Katus,
Christian W. Hamm,
Kurt Huber,
Jörn O. Vollert,
Martin Möckel
Affiliations
Evangelos Giannitsis
Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, 69120 Heidelberg, Germany
Tania Garfias-Veitl
Department of Cardiology and Pneumology, University of Göttingen Medical Center, German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
Anna Slagman
Department of Emergency Medicine Campus Mitte and Virchow and Department of Cardiology, Charité-Universitätsmedizin, 13353 Berlin, Germany
Julia Searle
Department of Emergency Medicine Campus Mitte and Virchow and Department of Cardiology, Charité-Universitätsmedizin, 13353 Berlin, Germany
Christian Müller
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
Stefan Blankenberg
Department of Cardiology, University Heart and Vascular Centre Hamburg, 20251 Hamburg, Germany
Stephan von Haehling
Department of Cardiology and Pneumology, University of Göttingen Medical Center, German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
Hugo A. Katus
Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, 69120 Heidelberg, Germany
Christian W. Hamm
Department of Cardiology, Campus Kerckhoff, University of Giessen, 61231 Bad Nauheim, Germany
Kurt Huber
3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, 1060 Vienna, Austria
Jörn O. Vollert
BRAHMS GmbH Deutschland, 16761 Berlin, Germany
Martin Möckel
Department of Emergency Medicine Campus Mitte and Virchow and Department of Cardiology, Charité-Universitätsmedizin, 13353 Berlin, Germany
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 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.
