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10.3390/cells11020211
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Article

Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial

by
Evangelos Giannitsis
1,*,
Tania Garfias-Veitl
2,
Anna Slagman
3,
Julia Searle
3,
Christian Müller
4,
Stefan Blankenberg
5,
Stephan von Haehling
2,
Hugo A. Katus
1,
Christian W. Hamm
6,
Kurt Huber
7,
Jörn O. Vollert
8 and
Martin Möckel
3
1
Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, 69120 Heidelberg, Germany
2
Department of Cardiology and Pneumology, University of Göttingen Medical Center, German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
3
Department of Emergency Medicine Campus Mitte and Virchow and Department of Cardiology, Charité-Universitätsmedizin, 13353 Berlin, Germany
4
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
5
Department of Cardiology, University Heart and Vascular Centre Hamburg, 20251 Hamburg, Germany
6
Department of Cardiology, Campus Kerckhoff, University of Giessen, 61231 Bad Nauheim, Germany
7
3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, 1060 Vienna, Austria
8
BRAHMS GmbH Deutschland, 16761 Berlin, Germany
*
Author to whom correspondence should be addressed.
Cells 2022, 11(2), 211; https://doi.org/10.3390/cells11020211
Submission received: 12 November 2021 / Revised: 29 December 2021 / Accepted: 30 December 2021 / Published: 8 January 2022
(This article belongs to the Special Issue Understanding Biomarkers in Cardiology)
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Abstract

Regarding the management of suspected Non-ST-segment-elevation acute coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8 randomized controlled trial study had reported non-inferiority for the incidence of major adverse cardiac events at 30 days in the Copeptin group (dual marker strategy of copeptin and hs-cTnT at presentation) compared to the standard process (serial hs-cTnT testing). However, in 349 (38.7%) of the 902 patients, high-sensitivity cardiac troponin was not available for the treating physicians. High sensitivity cardiac troponin T was re-measured from thawed blood samples collected at baseline. This cohort qualified for a re-analysis of the 30-day incidence rate of MACE (death, survived cardiac death, acute myocardial infarction, re-hospitalization for acute coronary syndrome, acute unplanned percutaneous coronary intervention, coronary bypass grafting, or documented life-threatening arrhythmias), or components of the primary endpoint including death or death/MI. After re-measurement of troponin and exclusion of 9 patients with insufficient blood sample volume, 893 patients qualified for re-analysis. A total of 57 cases were detected with high sensitivity cardiac troponin T ≥ 14 ng/L who had been classified as “troponin negative” based on a conventional cardiac troponin T or I < 99th percentile upper limit of normal. Major adverse cardiac events rates after exclusion were non-inferior in the Copeptin group compared to the standard group (4.34% (95% confidence intervals 2.60–6.78%) vs. 4.27% (2.55–6.66%)). Rates were 53% lower in the per-protocol analysis (HR 0.47, 95% CI: 0.18–1.15, p = 0.09). No deaths occurred within 30 days in the discharged low risk patients of the Copeptin group. Copeptin combined with high sensitivity cardiac troponin is useful for risk stratification and allows early discharge of low-to-intermediate risk patients with suspected acute coronary syndrome is as safe as a re-testing strategy at 3 h or later.
Keywords: acute coronary syndrome; randomized trial; risk stratification; safe discharge; copeptin; high sensitivity troponin T acute coronary syndrome; randomized trial; risk stratification; safe discharge; copeptin; high sensitivity troponin T

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MDPI and ACS Style

Giannitsis, E.; Garfias-Veitl, T.; Slagman, A.; Searle, J.; Müller, C.; Blankenberg, S.; von Haehling, S.; Katus, H.A.; Hamm, C.W.; Huber, K.; et al. Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial. Cells 2022, 11, 211. https://doi.org/10.3390/cells11020211

AMA Style

Giannitsis E, Garfias-Veitl T, Slagman A, Searle J, Müller C, Blankenberg S, von Haehling S, Katus HA, Hamm CW, Huber K, et al. Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial. Cells. 2022; 11(2):211. https://doi.org/10.3390/cells11020211

Chicago/Turabian Style

Giannitsis, Evangelos, Tania Garfias-Veitl, Anna Slagman, Julia Searle, Christian Müller, Stefan Blankenberg, Stephan von Haehling, Hugo A. Katus, Christian W. Hamm, Kurt Huber, and et al. 2022. "Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial" Cells 11, no. 2: 211. https://doi.org/10.3390/cells11020211

APA Style

Giannitsis, E., Garfias-Veitl, T., Slagman, A., Searle, J., Müller, C., Blankenberg, S., von Haehling, S., Katus, H. A., Hamm, C. W., Huber, K., Vollert, J. O., & Möckel, M. (2022). Biomarkers-in-Cardiology 8 RE-VISITED—Consistent Safety of Early Discharge with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute Coronary Syndrome—A Secondary Analysis of the Randomized Biomarkers-in-Cardiology 8 Trial. Cells, 11(2), 211. https://doi.org/10.3390/cells11020211

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