Abstract 16576: The Role of Undetectable Cardiac High Sensitivity Troponin T and Copeptin for Prediction of 90 Day Outcomes in Low- to Intermediate-Risk Patients With Suspected ACS: A BIC-8 Biomarker Substudy

Abstract

Introduction: The international randomized multicentre BIC-8 trial demonstrated that patients with suspected ACS and a negative baseline troponin, who also tested negative for copeptin, could safely be discharged and did not experience a higher rate of MACE within 30 days compared to patients managed according to current guidelines. Objective: This BIC8-substudy evaluates the usefulness of copeptin in patients with undetectable (below limit of detection (LOD)), compared to detectable (at or above LOD) high sensitivity troponin T (hsTnT) at presentation. Methods: In the original study, patients (n=902) were randomized 1:1 into standard and experimental arm. In the experimental arm, further patient care was based on copeptin levels at admission. After 30 and 90 days, a telephone follow-up was performed. Since hsTnT at LOD was evaluated in a post-randomization cohort, all analyses were executed on the entire study population. For the hsTnT assay (Elecsys, Roche), LOD was defined as a value below 5 ng/l. Copeptin values were determined using the BRAHMS Copeptin us Kryptor assay (Thermo Scientific). Results: Of all patients enrolled in the original study (n=902), hsTnT at admission was available in 893 patients (99.0%). The majority of patients had detectable hsTnT values (65.4%, n=584). 34.6% (n=309) had no detectable hsTnT-values. In these patients, no myocardial infarctions (MIs) or deaths occurred within 90 days. In patients with detectable hsTnT-values, in 3.3% the combined endpoint of death or MI occurred within 90 days (table 1). In the subgroup of patients with a copeptin value ≥10 pmol/l the event-rate was 8.2% (10/122) and in patients below this value 2.0% (9/441), (RR = 4.02, p=0.003). Conclusion: In low-to-intermediate risk patients with suspected ACS, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or MI within 90 days. In patients with detectable hsTnT, Copeptin is useful to stratify patients at higher risk for death/MI.