Biomarker strategy safe for ruling out acute MI in low-risk patients

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Testing for troponin and copeptin could have promise as an indicator of suspected acute coronary syndrome in patients who are low to intermediate risk. According to researchers, patients presenting with negative copeptin values could rule out acute MI and allow for early discharge from the emergency department.

German researchers randomly assigned standard care or copeptin assessment to 902 patients. In the copeptin group, both troponin and copeptin were assessed and utilized to guide discharge. Patients with positive copeptin values received further standard treatment, while patients with negative copeptin values were determined to be at low risk for acute coronary syndrome and discharged following an additional review of well-being. Copeptin and troponin values were also collected for patients who underwent standard care but their values were not disclosed to treating physicians.

They found that between the copeptin and standard-care groups, a lower proportion of major adverse cardiac events occurred in per protocol analysis at 30 days (3.01 percent vs. 5.34 percent, respectively). Martin Möckel, MD, PhD, of the Charité-University Medicine Berlin, and colleagues also noted that 67.6 percent of copeptin patients were discharged from the emergency department. Conversely, only 12 percent of standard care patients were discharged directly from the emergency department.

Intention to treat analysis had very similar proportions of patients in both groups experiencing major adverse cardiac events at 30 days (Copeptin vs. standard, 5.19 percent vs. 5.17 percent, respectively.)

They found the ratio of PCI and coronary angiography higher among the copeptin cohort compared to standard care, however, they noted no statistical significance. Further, event rates in copeptin negative patients was 0.6 percent.

While Möckel et al found the results promising, they wrote further work needed to be done to confirm their findings. Likewise, they noted that registries would help show whether copeptin assessment is a safe, useful tool or “as some fear – will be abused by busy ED [emergency department] physicians.”

This study was published in the Feb. 7 issue of the European Heart Journal.