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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

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-intermediat...

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Main Authors: Giannitsis, Evangelos (Author) , Clifford, Piers (Author) , Slagman, Anna (Author) , Rüdelstein, Ralph (Author) , Liebetrau, Christoph (Author) , Hamm, Christian (Author) , Honnart, Didier (Author) , Huber, Kurt (Author) , Vollert, Jörn Ole (Author) , Simonelli, Carlo (Author) , Schröder, Malte (Author) , Wiemer, Jan C. (Author) , Müller-Hennessen, Matthias (Author) , Schroer, Hinrich (Author) , Kastner, Kim (Author) , Möckel, Martin (Author)
Format: Article (Journal)
Language:English
Published: 2019
In: BMJ open
Year: 2019, Volume: 9, Issue: 7
ISSN:2044-6055
DOI:10.1136/bmjopen-2018-028311
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/bmjopen-2018-028311
Verlag, lizenzpflichtig, Volltext: https://bmjopen.bmj.com/content/9/7/e028311
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Author Notes:Evangelos Giannitsis, Piers Clifford, Anna Slagman, Ralph Ruedelstein, Christoph Liebetrau, Christian Hamm, Didier Honnart, Kurt Huber, Jörn Ole Vollert, Carlo Simonelli, Malte Schröder, Jan C. Wiemer, Matthias Mueller-Hennessen, Hinrich Schroer, Kim Kastner, Martin Möckel
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Summary: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.
Item Description:Gesehen am 19.03.2020
Physical Description:Online Resource
ISSN:2044-6055
DOI:10.1136/bmjopen-2018-028311

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