Improve Management of acute heart failure with ProcAlCiTonin in EUrope: results of the randomized clinical trial IMPACT EU Biomarkers in Cardiology (BIC) 18.

Autor: Möckel M; Department of Cardiology, Division of Emergency and Acute Medicine Campus Charité Mitte and Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany., de Boer RA; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Slagman AC; Department of Cardiology, Division of Emergency and Acute Medicine Campus Charité Mitte and Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany., von Haehling S; Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany., Schou M; Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark., Vollert JO; Clinical Diagnostics, Thermo Fisher Scientific, Hennigsdorf, Germany., Wiemer JC; Clinical Diagnostics, Thermo Fisher Scientific, Hennigsdorf, Germany., Ebmeyer S; Clinical Diagnostics, Thermo Fisher Scientific, Hennigsdorf, Germany., Martín-Sánchez FJ; Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain., Maisel AS; University of California, San Diego, CA, USA., Giannitsis E; Abteilung Innere Medizin III Kardiologie, Angiologie und Pneumologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Germany.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2020 Feb; Vol. 22 (2), pp. 267-275. Date of Electronic Publication: 2019 Dec 12.
DOI: 10.1002/ejhf.1667
Abstrakt: Aim: To determine whether initiation of antibiotic therapy (ABX) by procalcitonin (PCT) within 8 h of admission in patients presenting to the emergency department with symptoms and signs of acute heart failure (AHF) and elevated natriuretic peptides would improve clinical outcomes.
Methods and Results: The study was a randomized multicentre clinical trial conducted at 16 sites in Europe. Patients were randomized to either a PCT-guided strategy or standard care. Patients with PCT-guided strategy (n = 370) had ABX initiated if PCT was > 0.2 μg/L. Patients with standard care (n = 372) had AHF care in accordance with published guidelines without PCT. The primary endpoint was 90-day all-cause mortality. Pre-specified secondary endpoints included 30-day all-cause mortality and readmission and rate of pneumonia. The Data Safety and Review Committee recommended stopping the study for futility when 762 of the planned 792 patients had been enrolled. A total of 742 patients could be analysed. Patients were elderly (median age: 77 years), 38% were women, and had typical signs and symptoms of AHF. All-cause mortality at 90 days was 10.3% in the PCT-guided group vs. 8.2% in standard care (P = 0.316). Thirty-day readmission was significantly higher in the PCT-guided group vs. standard care but the difference vanished until day 90. The rate of pneumonia was overall low (7.5%) and not different between groups.
Conclusions: In patients with AHF, a strategy of PCT-guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes.
(© 2019 The Authors.European Journal of Heart Failure © 2019 European Society of Cardiology.)
Databáze: MEDLINE
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