A study to determine the ability of a blood test for B-type Natriuretic Peptide signal peptide (BNP-SP) to act as an early indicator in Acute Coronary Syndrome (ACS)).

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Early clinical detection of acute coronary syndromes (ACS) can be difficult. In particular, distinction between cardiac and non-cardiac events may entail 12-36 hours of delay whilst serial biomarker results are awaited and/or subsequent tests (such as exercise electrocardiography) are performed. We have achieved the first ever identification of a signal peptide in the circulation (B-type Natriuretic Peptide signal peptide (BNP-SP)) and show that it has potential to specifically and rapidly identify cardiac ischemia.. We will measure serial BNP-SP concentrations in 2000 patients presenting to the Emergency Department within 24 hours of symptom onset of possible Acute Coronary Syndrome (ACS). Clinical history and physical examination will be undertaken according to standard care . Venous blood samples for cardiac biomarkers will be obtained 1, 2, 3, hours post admission and again at 6-12, 24 & 48 hours if still in hospital or attending an outpatient clinic Patients will be followed up for 30 day and 6 month events for the composite end-point of: All cause mortality and/or new ACS and/or readmission to hospital with arrhythmia or heart failure. This research has the potential to speed up diagnosis and ultimately improve outcomes for patients with ACS.

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