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Kassem M, Ayala PL, Andric-Cancarevic T, Tajsic M, Vargas KG, Bendik D, Kaufmann C, Wojta J, Mueller C, Huber K. Copeptin for the differentiation of type 1 versus type 2 myocardial infarction or myocardial injury. Int J Cardiol 2024; 403:131879. [PMID: 38369132 DOI: 10.1016/j.ijcard.2024.131879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The rapid and reliable differentiation of myocardial infarction (MI) due to atherothrombosis (T1MI) from MI due to supply-demand mismatch (T2MI) or acute myocardial injury is of major clinical relevance due to very different treatments, but still a major unmet clinical need. This study aimed to investigate whether copeptin, a stress hormone produced in the hypothalamus, helps to differentiate between T1MI versus T2MI or injury. METHODS In a retrospective analysis, 1271 unselected consecutive patients presenting with symptoms suggestive of MI to the emergency department were evaluated. Patients diagnosed with ST-elevation MI were excluded. All patients with elevated cardiac troponin I (cTnI) concentration possibly indicating MI were classified into T1MI, T2MI, or acute myocardial injury using detailed clinical assessment and coronary imaging. Copeptin plasma concentration was measured in a blinded fashion. A multicenter diagnostic study with central adjudication of the final diagnosis served as external validation cohort (n = 1390). RESULTS Among 1161 patients, 154 patients had increased cTnI concentration. Of these, 78 patients (51%) were classified as T1MI and 76 (49%) as T2MI or myocardial injury. Patients with T2MI or myocardial injury had significantly higher copeptin plasma concentration between patients versus T1MI (21,4 pmol/l versus 8,1 pmol/l, p = 0,001). A multivariable regression analysis revealed that higher concentrations of copeptin and C-reactive protein, higher heart rate at presentation and lower frequency of smoking remained significantly associated with T2MI and myocardial injury. Findings were largely confirmed in the external validation cohort. CONCLUSION In patients without ST-segment elevation, copeptin concentration was higher in T2MI and myocardial Injury versus T1MI and may help in their differential diagnosis.
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Affiliation(s)
- Mona Kassem
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.
| | - Pedro Lopez Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland
| | - Tijana Andric-Cancarevic
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
| | - Milos Tajsic
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
| | - Kris G Vargas
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dimitri Bendik
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
| | - Johann Wojta
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
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Winkler S, Koehler K, Prescher S, Koehler M, Kirwan BA, Tajsic M, Koehler F. Is 24/7 remote patient management in heart failure necessary? Results of the telemedical emergency service used in the TIM-HF and in the TIM-HF2 trials. ESC Heart Fail 2021; 8:3613-3620. [PMID: 34182596 PMCID: PMC8497196 DOI: 10.1002/ehf2.13413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Aims Telemedical emergency services for heart failure (HF) patients are usually provided during business hours. However, many emergencies occur outside of business hours. This study evaluates if a 24/7 telemedical emergency service is needed for the remote management of high‐risk HF patients. Methods and results The study included 1119 patients merged from the TIM‐HF and TIM‐HF2 trials [age 69 ± 11, 73% male, left ventricular ejection fraction 37% ± 13, 557 New York Heart Association (NYHA) II/562 NYHA III]. Patients received a 24/7 physician‐guided emergency service provided by the telemedical centre (TMC) in addition to remote management within business hours. During emergency calls, patient status, symptoms, electronic patient record, and instant telemonitoring data were evaluated by the TMC physician. Following diagnosis, patients were referred for hospital admission or instructed to stay at home. Apart from the TMC, patients could place a call to the public emergency service at any time. Seven hundred sixty‐eight emergency calls were placed over 1383 patient years (0.56 calls/patient year). Five hundred twenty‐six calls (69%) occurred outside business hours. There were 146 (19%) emergency calls for worsening HF, 297 (39%) other cardiovascular, and 325 (42%) non‐cardiac causes, with a similar pattern inside and outside business hours. Of the 1119 patients, 417 (37%) placed at least one emergency call. Patients with NYHA Class III, higher N‐terminal prohormone of brain natriuretic peptide (>1.400 pg/mL) levels, ischaemic aetiology of HF, implanted defibrillator, and impaired renal function had a higher probability of placing emergency calls. During study follow‐up, patients who made an emergency call had a higher all‐cause mortality (22% vs. 11%, P = 0.007 in TIM‐HF; 16% vs. 4%, P < 0.001 in TIM‐HF2) and more unplanned hospitalizations (324 vs. 162, P < 0.001 in TIM‐HF; 545 vs. 180, P < 0.001 in TIM‐HF2). Of the total 1,211 unplanned hospital admissions, 492 (41%) were initiated by a patient emergency call. Three hundred seventy‐nine calls (49%) were placed to the TMC, whereas 389 calls (51%) were made to the public emergency service. Three hundred twenty‐six (84%) of the calls to the public emergency service resulted in acute hospitalizations. The TMC initiated 202 (53%) hospital admissions; 177 (47%) patients were advised to stay at home. All patients that remained at home were alive during a prespecified safety period of 7 days post‐call. Diagnoses made by the TMC physician were confirmed in 83% of cases by the hospital. Conclusion A telemedical emergency service for high‐risk HF patients is safe and should operate 24/7 to reduce unplanned hospitalizations. Emergency calls could be considered as a marker for higher morbidity and mortality.
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Affiliation(s)
- Sebastian Winkler
- Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany.,Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Kerstin Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Sandra Prescher
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Magdalena Koehler
- Ludwig-Maximilians Universität München, Munich, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, University Hospital 'Klinikum rechts der Isar', School of Medicine, Technical University Munich, Munich, Germany
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland; Faculty of Epidemiology and Public Health London School of Hygiene & Tropical Medicine, University College London, London, UK
| | - Milos Tajsic
- Emergency Department, Wilhelminenspital Wien, Vienna, Austria
| | - Friedrich Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Vargas K, Tajsic M, Latsuzbaia A, Andric T, Kassem M, Jaeger B, Huber K. Sex-based differences of copeptin for early rule-out of non-ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
There is paucity of data on the role of sex in the dual biomarker strategy using copeptin and conventional troponin for the early rule-out of non-ST-elevation myocardial infarction (NSTEMI). We aimed to evaluate sex-based differences on copeptin levels, combined negative predictive value (NPV) and predictors of copeptin elevation at admission.
Methods
Biomarkers were measured in 852 adult patients presenting to the emergency department with chest pain and suspected NSTEMI. Logistic regression analyses on predictors of copeptin elevation were evaluated by sex.
Results
Overall, 362 women (42.5%) and 490 men (57.5%) were included. Copeptin levels were higher in men (median 7.36 pmol/L vs. 4.8 pmol/L; P<0.001). Men had a similar NPV (100%) as women (99.6%, CI: 98.8–100) using the dual biomarker rule-out strategy and when compared to troponin alone (men, NPV=98.7%, CI: 97.5–99.8; and women, NPV=98.7%, CI: 97.5–100). Multivariate logistic regression showed positive association of male sex with copeptin elevation (OR=2.37; CI: 1.61–3.49; P<0.001). In men, diastolic blood pressure was a negative predictor of copeptin elevation (OR=0.98, 95% CI: 0.96–0.99), while positive predictors were current MI (OR=2.16, 95% CI: 1.19–3.91), chronic renal insufficiency (OR=3.58, 95% CI: 1.33–9.62), and atrial fibrillation (OR=2.56, 95% CI: 1.23–5.32), respectively (all P<0.05). In women, current MI (OR=2.98, CI: 1.23–7.24), atrial fibrillation (OR=2.90, CI: 1.26–6.70) and syncope (OR=7.56, CI: 2.26–25.30) were significant predictors of copeptin elevation.
Conclusions
Men with suspected NSTEMI have higher copeptin levels. The dual biomarker rule-out strategy has a similar performance in both male and female patients. Certain predictors of copeptin elevation are sex-specific.
Copeptin levels at presentation
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
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Affiliation(s)
- K.G Vargas
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - M Tajsic
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - A Latsuzbaia
- National Health Laboratory, Epidemiology and Microbial Genomics, Dudelange, Luxembourg
| | - T Andric
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - M Kassem
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - B Jaeger
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - K Huber
- Wilhelminenhospital, 3rd Department of Cardiology and Sigmund Freud University, Medical Faculty, Vienna, Austria
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Tajsic M, Járai R, Koch J, Stangl K, Wojta J, Dreger H, Huber K. Midregional pro-A-type natriuretic peptide as part of a dual biomarker strategy for the early rule out of non-ST segment elevation acute coronary syndrome – The WilCop study. Int J Cardiol 2018; 273:243-248. [DOI: 10.1016/j.ijcard.2018.09.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 12/01/2022]
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Koehler F, Koehler K, Deckwart O, Prescher S, Wegscheider K, Kirwan BA, Winkler S, Vettorazzi E, Bruch L, Oeff M, Zugck C, Doerr G, Naegele H, Störk S, Butter C, Sechtem U, Angermann C, Gola G, Prondzinsky R, Edelmann F, Spethmann S, Schellong SM, Schulze PC, Bauersachs J, Wellge B, Schoebel C, Tajsic M, Dreger H, Anker SD, Stangl K. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018; 392:1047-1057. [PMID: 30153985 DOI: 10.1016/s0140-6736(18)31880-4] [Citation(s) in RCA: 381] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Remote patient management in patients with heart failure might help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failure decompensation. We aimed to investigate the efficacy of our remote patient management intervention on mortality and morbidity in a well defined heart failure population. METHODS The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial was a prospective, randomised, controlled, parallel-group, unmasked (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. The trial was done in Germany, and patients were recruited from hospitals and cardiology practices. Eligible patients had heart failure, were in New York Heart Association class II or III, had been admitted to hospital for heart failure within 12 months before randomisation, and had a left ventricular ejection fraction (LVEF) of 45% or lower (or if higher than 45%, oral diuretics were being prescribed). Patients with major depression were excluded. Patients were randomly assigned (1:1) using a secure web-based system to either remote patient management plus usual care or to usual care only and were followed up for a maximum of 393 days. The primary outcome was percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death, analysed in the full analysis set. Key secondary outcomes were all-cause and cardiovascular mortality. This study is registered with ClinicalTrials.gov, number NCT01878630, and has now been completed. FINDINGS Between Aug 13, 2013, and May 12, 2017, 1571 patients were randomly assigned to remote patient management (n=796) or usual care (n=775). Of these 1571 patients, 765 in the remote patient management group and 773 in the usual care group started their assigned care, and were included in the full analysis set. The percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause death was 4·88% (95% CI 4·55-5·23) in the remote patient management group and 6·64% (6·19-7·13) in the usual care group (ratio 0·80, 95% CI 0·65-1·00; p=0·0460). Patients assigned to remote patient management lost a mean of 17·8 days (95% CI 16·6-19·1) per year compared with 24·2 days (22·6-26·0) per year for patients assigned to usual care. The all-cause death rate was 7·86 (95% CI 6·14-10·10) per 100 person-years of follow-up in the remote patient management group compared with 11·34 (9·21-13·95) per 100 person-years of follow-up in the usual care group (hazard ratio [HR] 0·70, 95% CI 0·50-0·96; p=0·0280). Cardiovascular mortality was not significantly different between the two groups (HR 0·671, 95% CI 0·45-1·01; p=0·0560). INTERPRETATION The TIM-HF2 trial suggests that a structured remote patient management intervention, when used in a well defined heart failure population, could reduce the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Kerstin Koehler
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Deckwart
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Prescher
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bridget-Anne Kirwan
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sebastian Winkler
- Clinic for Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Leonhard Bruch
- Clinic for Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Michael Oeff
- Telemedicine Centre, Department of Cardiology, Municipal Hospital Brandenburg/Havel and Brandenburg Medical School, Brandenburg/Havel, Germany
| | | | - Gesine Doerr
- Clinic for Internal Medicine, St Josefs-Krankenhaus Potsdam, Potsdam, Germany
| | - Herbert Naegele
- Department for Heart Insufficiency and Device Therapy, Albertinen Cardiovascular Centre, Hamburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center (CHFC) Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | - Christian Butter
- Immanuel Hospital Bernau, Brandenburg Heart Center, Department of Cardiology and Medical School Brandenburg Theodor Fontane, Bernau, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center (CHFC) Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | | | - Roland Prondzinsky
- Department of Internal Medicine I, Carl-von-Basedow-Klinikum Merseburg, Merseburg, Germany
| | - Frank Edelmann
- Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Sebastian Spethmann
- Federal Armed Forces Hospital Berlin, Division of Cardiology, Department of Internal Medicine, Berlin, Germany
| | | | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Johann Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - Brunhilde Wellge
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schoebel
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Milos Tajsic
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; University Medical Center Göttingen, Department of Cardiology and Pneumology, Göttingen, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
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Vargas KG, Tajsic M, Kassem M, Jarai R, Huber K. COPEPTIN AND HIGH-SENSITIVITY TROPONIN I IN PATIENTS WITH CHEST PAIN AND RECENT SYNCOPE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Möckel M, Searle J, Hamm C, Slagman A, Blankenberg S, Huber K, Katus H, Liebetrau C, Müller C, Muller R, Peitsmeyer P, von Recum J, Tajsic M, Vollert JO, Giannitsis E. Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J 2015; 36:369-76. [PMID: 24786301 PMCID: PMC4320319 DOI: 10.1093/eurheartj/ehu178] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/28/2014] [Accepted: 04/02/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS This randomized controlled trial (RCT) evaluated whether a process with single combined testing of copeptin and troponin at admission in patients with low-to-intermediate risk and suspected acute coronary syndrome (ACS) does not lead to a higher proportion of major adverse cardiac events (MACE) than the current standard process (non-inferiority design). METHODS AND RESULTS A total of 902 patients were randomly assigned to either standard care or the copeptin group where patients with negative troponin and copeptin values at admission were eligible for discharge after final clinical assessment. The proportion of MACE (death, survived sudden cardiac death, acute myocardial infarction (AMI), re-hospitalization for ACS, acute unplanned percutaneous coronary intervention, coronary artery bypass grafting, or documented life threatening arrhythmias) was assessed after 30 days. Intention to treat analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI) 3.30-7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32-7.69%; 23/443) in the copeptin group. In the per protocol analysis, the MACE proportion was 5.34% (95% CI 3.38-7.97%) in the standard group, and 3.01% (95% CI 1.51-5.33%) in the copeptin group. These results were also corroborated by sensitivity analyses. In the copeptin group, discharged copeptin negative patients had an event rate of 0.6% (2/362). CONCLUSION After clinical work-up and single combined testing of troponin and copeptin to rule-out AMI, early discharge of low- to intermediate risk patients with suspected ACS seems to be safe and has the potential to shorten length of stay in the ED. However, our results need to be confirmed in larger clinical trials or registries, before a clinical directive can be propagated.
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Affiliation(s)
- Martin Möckel
- Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Julia Searle
- Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Christian Hamm
- Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany Medical Clinic I, University Hospital Gießen, Gießen, Germany
| | - Anna Slagman
- Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Kurt Huber
- Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria
| | - Hugo Katus
- Department of Angiology, Cardiology and Pneumology, University Hospital Heidelberg, Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany Medical Clinic I, University Hospital Gießen, Gießen, Germany
| | | | - Reinhold Muller
- School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia
| | - Philipp Peitsmeyer
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Johannes von Recum
- Division of Emergency Medicine and CPU, Department of Cardiology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Milos Tajsic
- Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria
| | - Jörn O Vollert
- Thermo Fisher Scientific, Clinical Diagnostics, B·R·A·H·M·S GmbH, Hennigsdorf, Germany
| | - Evangelos Giannitsis
- Department of Angiology, Cardiology and Pneumology, University Hospital Heidelberg, Germany
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Tajsic M, Jarai R, Schwarz MA, Kitzbrecht J, Koch J, Wojta J, Huber K. Copeptin as a part of the dual biomarker strategy for early diagnosis of non ST segment elevation myocardial infarction WILCOP study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tajsic M, Jarai R, Kitzbrecht J, Koch J, Wojta J, Huber K. COPEPTIN AS A PART OF THE DUAL BIOMARKER STRATEGY FOR EARLY DIAGNOSIS OF NSTEMI: WILCOP STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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