Heart attack biomarker could ease ER crowding

Scientists think they have a litmus test for acute coronary syndrome that may also solve emergency room overcrowding. Researchers believe they've found a biomarker that can instantly determine which patients with chest pain are actually at risk of heart attack and which can be safely discharged.

The key is copeptin, which marks severe hemodynamic stress and can be detected immediately in acute myocardial infarction (MI) patients. A combination of copeptin and the protein cardiac troponin have predicted acute events in observational studies, and results of the Biomarkers in Cardiology 8 (BIC-8) trial, presented Tuesday at the European Society of Cardiology 2013 Congress in Amsterdam, proved no different.

In the trial, researchers tested 902 patients at low-to-intermediate risk of acute coronary syndrome (ACS). After negative troponin tests, half the patients underwent a copeptin assay while the other half received standard care. Of those who underwent the copeptin assay, patients with positive copeptin test results received standard ACS care, while those who had low levels were discharged. After 30 days, the difference in the rate of major adverse cardiovascular events (MACE) was not statistically significant between the two groups.

According to lead investigator Dr. Martin Mockel of Charité-Universitätsmedizin, a university hospital in Berlin, the test could dramatically free up emergency facilities by sending home those who are not at serious risk. As Mockel stated during a press conference (as quoted by Heartwire), only 10% of emergency room visitors who arrive with chest pain are actually experiencing a heart attack. "We do an extensive workup on patients who do not need specific cardiovascular care," he said.

Still, negative troponin and copeptin tests can't take the place of a doctor. Mockel said those tests would be followed by a clinical assessment of the patient before discharge. "The marker doesn't substitute for a brain," Mockel said.

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