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Recommendations

1.1 The BRAHMS copeptin assay shows potential to reduce the time taken to rule out myocardial infarction in patients presenting with acute chest pain, when used in combination with cardiac troponin testing. However there is currently insufficient evidence on its use in clinical practice to support the case for routine adoption of the BRAHMS copeptin assay in the NHS.

1.2 Research is recommended in the UK clinical setting to compare the BRAHMS copeptin assay in combination with cardiac troponin testing against sequential cardiac troponin testing for ruling out myocardial infarction. NICE will review this guidance when new and substantive evidence becomes available.

1.3 Research should document what happens to all patients presenting with acute chest pain in the chosen clinical settings, to allow investigation of the proportion of patients for whom use of the BRAHMS copeptin assay results in changes in management. Accurate recording of the times between steps in management will be important. Outcomes should measure the resource use implications of the earlier ruling out of myocardial infarction, and the impact this has on decisions to discharge patients from hospital or to investigate them further. Changes in the experience of patients as a result of using the BRAHMS copeptin assay should also be reported.