The National Institute for Health and Clinical Excellence (NICE) today (22 June), publishes medical technology guidance on the use of a test to rule out myocardial infarction (heart attack) in patients who have acute chest pain. The conclusions highlight that the BRAHMS copeptin assay shows potential to reduce the time taken to rule out myocardial infarction when used alongside a current test. The guidance recommends that more research is needed on the impact of the BRAHMS copeptin assay in clinical practice, before it can be supported for routine adoption in the NHS. This recommendation does not mean that the NHS shouldn’t use the test but that they should help with the collection of the further evidence required for future NICE evaluation.

The BRAHMS copeptin assay is a blood test to help clinicians decide if patients presenting to hospital with acute chest pain have had a heart attack. It’s intended to be used in conjunction with standard cardiac troponin testing (where raised levels of the biochemical marker troponin might indicate a heart attack) to reduce the time needed to exclude a heart attack. At present, at least two troponin tests 9 -12 hours apart are needed to rule out a heart attack. Copeptin is a surrogate marker for a hormone that is present at higher levels within 4 hours of a heart attack occurring, whereas troponin levels peak at 12 hours after symptoms appear. If the result of both the copeptin test and troponin test are negative, this has the potential to be used to support clinical findings in ruling out heart attack sooner after patients present with acute chest pain.

Dr Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: “The Medical Technology Advisory Committee (MTAC) thought that the BRAHMS copeptin assay is a promising new development for ruling out heart attack at an earlier stage in patients presenting with chest pain. There was uncertainty about the proportion of patients presenting with chest pain who would benefit from its use, and about the amount of time and resources that would be saved in routine practice. This meant that, at this stage, MTAC could not recommend that the NHS should consider routinely adopting the Brahms copeptin assay.

“However it is very important to note that this recommendation doesn’t mean that the BRAHMS copeptin assay should not be used. MTAC concluded that it would be useful to undertake good quality clinical studies to confirm the potential of the BRAHMS copeptin assay to offer advantages to patients and the NHS. MTAC wished to give strong encouragement to further research in NHS clinical settings on using BRAHMS copeptin assay for ruling out heart attacks earlier.”