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
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
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DOI：
10.1136/bmjopen-2018-028311
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Moeckel, Martin
中科院分区：
文献类型：
--
作者：
Giannitsis, Evangelos;Clifford, Piers;Moeckel, Martin
目的：关于疑似急性冠脉综合征（ACS）患者排除心肌梗死后早期从急诊科（ED）出院的安全性信息很少。该前瞻性登记旨在确认低至中等风险患者的随机研究结果，这些患者具有更广泛的症状，跨越不同的机构标准，并采用一系列局部肌钙蛋白检测，包括高灵敏度cTn (hs-cTn)，心脏肌钙蛋白（cTn）和护理点肌钙蛋白（POC Tn）。前瞻性设计，多中心欧洲注册。在9个欧洲国家（德国、奥地利、瑞士、法国、西班牙、英国、土耳其、立陶宛和匈牙利）设置18个急诊科。最终研究队列包括2294例疑似ACS患者（男性57.2%，中位年龄57岁）。采用新的双标记策略，1477例患者符合直接出院的条件，974例（42.5%）患者实现了直接出院。主要终点是30天的全因死亡率。结果与常规治疗组相比，双标记物治疗组ED的中位停留时间缩短了60分钟（228分钟，95% CI: 219 ~ 239分钟vs 288分钟，95% CI: 279 ~ 300分钟）。双标记物测量后，DMS原发出院组全因死亡率为0.1% (95% CI: 0% - 0.6%)，而常规随访组全因死亡率为1.1% （95% CI: 0.6% - 1.8%）。503例患者（21.9%）尽管DMS生物标志物呈阴性，但仍进行常规检查而不是出院，这与ACS的较高患病率相关(17.1% vs 0.9%, p
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