The acute chest pain is responsible for more than 11 % of queries to an emergency service . Only 10% of these patients really have an acute myocardial infarction. The standard protocol for managing these patients includes serial electrocardiogram, dosage of biomarkers and an observation time of 6-12 hours. This overloads the emergency services and affects the quality of care. Copetin is a biomarker of hemodynamic stress that increases immediately after a heart attack. A combination of troponin and copetin have demonstrated a negative predictive value of 99 % for stroke in observational studies.
This study randomized 902 patients with suspected acute coronary syndromes and initially negative troponin . One group received the standard protocol of care and the other group was administered with copetin and if this was negative they were granted discharge. If it is positive the patient received the normal process of care. The primary endpoint was a composite of death from all causes , a survivor of sudden death, stroke, re-hospitalization, unplanned coronary intervention , CABG and severe arrhythmias at 30 days. There was no difference in the primary end point ( 5.46 % versus 5.5 % ) among patients with copetin positive and negative . The 66 % of patients with negative copetin were discharged immediately versus 12% of patients in the standard protocol ( p < 0.001 ) .
Conclusion :
The early discharge in patients with suspected acute coronary syndrome was safe when troponin and copetin were negative. No increased incidence of events in patients was observed with negative copetin and early discharge
Martin Möckel
2013-09-03
Original title: Biomarkers in Cardiology-8 Study (BIC 8)