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.

Autor:	Giannitsis E; Cardiology, University of Heidelberg, Heidelberg, Germany., Clifford P; Buckinghamshire Healthcare NHS Trust, Amersham, UK., Slagman A; Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany.; College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia., Ruedelstein R; Cardiology, St. Elisabeth Krankenhaus, Mayen, Germany., Liebetrau C; Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.; Partner Site, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany., Hamm C; Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.; Partner Site, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany., Honnart D; Hôpital du Bocage, CHU Dijon, Dijon, France., Huber K; 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.; Medical School, Sigmund Freud University, Vienna, Austria., Vollert JO; Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany., Simonelli C; Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany., Schröder M; Cardiology, Krankenhaus Hedwigshohe Berlin, Berlin, Germany., Wiemer JC; Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany., Mueller-Hennessen M; Cardiology, University of Heidelberg, Heidelberg, Germany., Schroer H; Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany., Kastner K; Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany., Möckel M; Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany.; College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2019 Jul 23; Vol. 9 (7), pp. e028311. Date of Electronic Publication: 2019 Jul 23.
DOI:	10.1136/bmjopen-2018-028311
Abstrakt:	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. Competing Interests: Competing interests: EG received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer, Daiichi-Sankyo, Lilly Eli Deutschland. He serves as a consultant for Roche Diagnostics, BRAHMS Thermo Fisher Scientific, Boehringer Ingelheim and has received research funding from BRAHMS Thermo Fisher Scientific, Roche Diagnostics, Bayer Vital and Daiichi Sankyo; AS has received research funding from Roche Diagnostics, BRAHMS Thermofisher Scientific and the German Research Council (DFG); MM received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer Vital, Daiichi-Sankyo, Boehringer Ingelheim and BRAHMS Thermo Fisher Scientific. He serves as a consultant for BRAHMS Thermo Fisher Scientific and Bayer, and has received research funding from BRAHMS Thermo Fisher Scientific, Roche Diagnostics and Radiometer. CS, JOV, JCW are employees of BRAHMS Thermo Fisher Scientific. MM-H report research grants from Roche Diagnostics, BRAHMS Thermo Fisher Scientific and the University of Heidelberg. Speaker honoraria from RocheDiagnostics KK reports fees from BRAHMS Thermo Fisher Scientific for monitoring activities related to the study. DH reports speakers fees from BRAHMS Thermo Fisher Scientific. KH received honoraria for lectures from AstraZeneca, Bayer, Boehringer Ingelheim, BRAHMS Thermo Fisher Scientific, Daiichi Sankyo, Pfizer, Sanofi and The Medicines Company and has received research funding form AstraZeneca and BRAHMS Thermo Fisher, respectively. ChH and CPC report speakers fees and honoraria for consultancy from BRAHMS Thermo Fisher Scientific. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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