Multicentre cross-sectional observational registry to monitor the safety of early discharge after rule-out of acute myocardial infarction by copeptin and troponin: the Pro-Core registry. Issue 7 (23rd July 2019)

• Record Type: Journal Article
• Authors: Giannitsis, Evangelos; Clifford, Piers; Slagman, Anna; Ruedelstein, Ralph; Liebetrau, Christoph; Hamm, Christian; Honnart, Didier; Huber, Kurt; Vollert, Jörn Ole; Simonelli, Carlo; Schröder, Malte; Wiemer, Jan C; Mueller-Hennessen, Matthias; Schroer, Hinrich; Kastner, Kim; Möckel, Martin
• Is Part Of: BMJ open. Volume 9:Issue 7(2019)
• Publication Date: 2019-07-23
• Subjects: registry -- acute coronary syndrome -- myocardial infarction -- copeptin -- troponin -- mortality; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-028311
• Languages: English
• ISSNs: 2044-6055

Abstract

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 .