(Press-News.org) AMSTERDAM, The Netherlands – An emergency department strategy that uses two biomarkers to triage patients with suspected acute coronary syndrome (ACS) can increase the rate of early, safe hospital discharge, according to results of the Biomarkers in Cardiology 8 (BIC-8) trial.
"This biomarker strategy using a state-of-the-art quantitative troponin assay in combination with an ultrasensitive copeptin assay has the potential to change clinical practice with high patient safety," said lead investigator Martin Möckel, MD, PhD, from Charité - Universitätsmedizin Berlin, in Berlin, Germany.
"This is the first interventional trial to study whether it is safe to discharge suspected ACS patients who test troponin and copeptin negative at admission. Using this strategy, a high proportion of patients could be discharged early, thus unnecessary treatments and resources could be saved, causing a substantial benefit for patients and health care providers."
Emergency departments worldwide face increasing overcrowding and patients with signs and symptoms which might be caused by an acute coronary syndrome are very common, even though only around 15% of these patients are ultimately diagnosed with an acute myocardial infarction as the underlying disease, explained Dr. Möckel.
"Rapid rule-out of acute myocardial infarction (MI) is therefore a major clinical need, saving the health care system time and resources and patients unnecessary stress, anxiety and other risks associated with hospitalization."
Current guidelines recommend that patients receive serial troponin testing to confirm that hospital discharge is appropriate, but this testing delays definitive action, he said.
"The new biomarker copeptin has been shown to be elevated in patients first presenting with acute MI, and when combined with the cardiac troponin biomarker has an excellent negative predictive value for acute MI. However, an early discharge strategy based on combining these two tests has never been assessed prospectively."
BIC-8, a multicentre, open, randomized, controlled clinical trial included 902 patients with an initial negative troponin test to assess this strategy.
In the experimental arm (n=451), patients with a negative copeptin test (less than 10 pmol/L) were discharged into ambulant care, with a scheduled outpatient visit within 72 hours, while those with a positive copeptin test received standard treatment according to current guidelines.
Among patients in the standard arm (n=451), copeptin results were not available to treating staff and patients were treated according to current guidelines.
At 30 days of follow-up the rate of major adverse cardiovascular events (MACE) was similar in both groups (5.46% in the experimental arm vs 5.5% in the standard arm), but emergency room discharge rates were significantly higher in the experimental arm (66% vs 12%; P < 0.001).
The results support the consideration of a new treatment algorithm in low-to-intermediate risk patients with suspected ACS, said Dr. Möckel.
"Patients with a negative troponin and a negative copeptin result at admission can safely be discharged if the final clinical assessment is consistent with this decision, as long as a timely diagnostic work-up is done in the outpatient setting," he said.
However, the clinical judgment of the treating physician is of utmost importance, he stressed.
"If his or her final clinical assessment excludes discharge due to high suspicion of ACS, perhaps due to recurrent symptoms or an updated history, the patient should not be discharged despite negative biomarker results."
###
SOURCES OF FUNDING :
This investigator initiated trial was funded by a research grant of B.R.A.H.M.S GmbH a ThermoFisher company
DISCLOSURES:
MM, JS and AS received research grants from Thermo Scientific BRAHMS, Radiometer, Siemens and Abbott; MM received lecture and consultancy honoraria from Bayer, Astra Zeneca and The Medicines Company; CH has received speaker honoraria and is member of the advisory board for Thermo Scientific BRAHMS; SB has received research funding from Abbott, Abbott Diagnostics, Bayer, Boehringer Ingelheim, Siemens and Thermo Fisher. He received honoraria for lectures from Abbott, Abbott Diagnostics, Astra Zeneca, Bayer, Boehringer Ingelheim, Medtronic, Pfizer, Roche, Siemens Diagnostics, Siemens, Thermo Fisher and as a member of Advisory Boards and for consulting for Boehringer Ingelheim, Bayer, Novartis, Roche and Thermo Fisher; KH has no conflict of interests to declare; CM has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, Abbott, Alere, BRAHMS, Nanosphere, Roche, Siemens, 8sense, Critical Diagnostics, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria and consultancy fees from Abbott, Alere, BG Medicine, BRAHMS, Novartis, Roche, and Siemens; JOV is employed at Thermo Fisher, Brahms GmbH in Henningsdorf, Germany as a medical director; EG has received honoraria for lectures from Roche Diagnostics, he received honoraria for lectures and consultancy fees from BRAHMS GmbH.
NOTE TO EDITORS
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2013
The ESC Congress is currently the world's premier conference on the science, management and prevention of cardiovascular disease. The spotlight of this year's event is "The Heart Interacting with Systemic Organs". ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information is available from the ESC Press Office at press@escardio.org
END
AMSTERDAM, The Netherlands – Omecamtiv mecarbil, a cardiac myosin-activator, did not achieve its primary efficacy endpoint in reducing dyspnoea (shortness of breath) in patients with acute heart failure, according to the results of the phase II ATOMIC-AHF (Acute Treatment with Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure) study.
However, a cohort which received the highest dose of the drug showed greater dyspnoea relief compared with placebo, and there were also other favourable dose and concentration-related trends, noted lead investigator John ...
AMSTERDAM, The Netherlands – The blood pressure lowering drug aliskiren did not improve coronary artery disease when given to patients who had prehypertension, results of the Aliskiren Quantitative Atherosclerosis Regression Intravascular Ultrasound Study (AQUARIUS) reveal.
The findings, reported at the European Society of Cardiology Congress with simultaneous publication in the Journal of the American Medical Association, offer new insight into the value of lowering blood pressure beyond prehypertensive goals, suggested lead investigator Stephen Nicholls MBBS, PhD, Deputy ...
Use of bioprosthetic heart valves has dramatically increased (from 18% in 1991 to 59% in 2003), mainly in older patients with comorbidities. This is due to the increased risk of bleeding complications associated with lifelong use of anticoagulation for mechanical prostheses.
But structural valve deterioration is one the main complications associated with bioprosthetic heart valves. In large registries including more than 300 000 patients undergoing aortic valve replacement the reoperation rate for patients receiving a bioprosthesis was 3.1% at 11-13 years of follow-up ...
Dr Sherif said: "Earlier studies on the impact of gender on outcome after transcatheter aortic valve implantation (TAVI) have had conflicting results. A Canadian study reported in 641 consecutive patients that female sex is associated with a better long-term and short-term survival after TAVI.1 An Italian study of 305 high risk patients found no gender differences in composite safety and efficacy endpoints at 30 days and one year after TAVI."2
The current analysis examined gender differences in outcomes for 1432 consecutive patients from 27 centers who were enrolled in ...
Bicuspid aortic valve (BV) is the most common congenital valvular abnormality, occurring in 1-2% of the general population. Two of the aortic valvular leaflets fuse during development resulting in a valve that is bicuspid instead of the normal tricuspid configuration. BV is associated with increased mechanical stress which predisposes to calcification and development of aortic stenosis which narrows the opening of the aortic valve.
Dr Bauer said: "TAVI is used to treat elderly high risk patients with severe aortic stenosis. Despite previous assumptions the frequency of ...
Measures taken in developed countries to reduce noncommunicable diseases – the leading causes of death globally – have improved the life expectancy of women aged 50 years and older over the last 20 to 30 years. But, according to a study that will be published in the Bulletin of the World Health Organization on 2 September, the gap in life expectancy between such women in rich and poor countries is growing.
The WHO study, one of a collection of articles in a special issue of the journal devoted to women's health beyond reproduction, found that the leading causes of death ...
Helicobacter pylori is a bacterium that establishes a life-long stomach infection in humans, which in some cases can lead to duodenal ulcers or stomach cancer. New research, presented at this week's Society for General Microbiology Autumn Conference, gives us a clearer understanding of how these bacteria can manipulate the human immune system to survive in the mucosal lining of the stomach.
Researchers from the University of Nottingham have shown that H. pylori is able to supress the body's normal production of 'human beta defensin 1' (hβD1), an antimicrobial factor ...
OKLAHOMA CITY, September 1, 2013 — A new finding could lead to novel treatments to reduce bleeding in trauma and severe infections.
The research, from Oklahoma Medical Research Foundation scientists Lijun Xia, M.D., Ph.D., Jianxin Fu, M.D., Ph.D., and Brett Herzog, Ph.D., appears in the most recent issue of the journal Nature.
One way the immune system keeps a body healthy is through immune surveillance. Lymphocytes, a type of white blood cell, constantly exit the bloodstream and "check in" at the lymph nodes to learn about possible pathogens or abnormal cell growth. ...
A new study has revealed that global warming is resulting in the spread of crop pests towards the North and South Poles at a rate of nearly 3 km a year. The study, published in the journal Nature Climate Change and carried out by researchers at the University of Exeter and the University of Oxford, shows a strong relationship between increased global temperatures over the past 50 years and expansion in the range of crop pests.
Currently 10-16% of global crop production is lost to pests. Crop pests include fungi, bacteria, viruses, insects, nematodes, viroids and oomycetes. ...
For years, physicians around the world have watched as strain after strain of the deadly bacteria Mycobacterium tuberculosis evolves resistance to drugs.
Over the last few decades researchers have used the tools of molecular biology to identify a handful of individual mutations that allow TB to withstand many of the key therapeutics that doctors use to treat it. These genetic markers serve as clues for new drug development and as tools for diagnosing drug-resistant strains of TB. But the pace of discovery has proven too slow in the face of the complex array of rapidly ...
