Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 190, Issue -, Pages 170-176Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2015.04.133
Keywords
Acute myocardial infarction; Copeptin; Highly sensitive Troponin I; Sensitivity and specificity
Categories
Funding
- Swiss National Science Foundation [PP00B-102853, PASMP3-136995]
- Swiss Heart Foundation
- University Basel
- Abbott
- BRAHMS
- Roche
- Siemens
- Department of Internal Medicine, University Hospital Basel
- Alere
- Beckman Coulter
- Critical Diagnostics
- Nanosphere
- Singulex
- 8sense
- Department of Internal Medicine, of the University Hospital Basel
- University of Basel
- Professor Max Cloetta Foundation
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Background: The incremental value of copeptin, a novel marker of endogenous stress, for rapid rule-out of non-ST-elevation myocardial infarction (NSTEMI) is unclear when sensitive or even high-sensitivity cardiac troponin cTn (hs-cTn) assays are used. Methods: In an international multicenter study we evaluated 1929 consecutive patients with symptoms suggestive of acute myocardial infarction (AMI). Measurements of copeptin, three sensitive and three hs-cTn assays were performed at presentation in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists using all clinical information including coronary angiography and levels of hs-cTnT. The incremental value in the diagnosis of NSTEMI was quantified using four outcome measures: area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), sensitivity and negative predictive value (NPV). Early presenters (<4 h since chest pain onset) were a pre-defined subgroup. Results: NSTEMI was the adjudicated final diagnosis in 358 (18.6%) patients. As compared to the use of cTn alone, copeptin significantly increased AUC for two (33%) and IDI (between 0.010 and 0.041 (all p < 0.01)), sensitivity and NPV for all six cTn assays (100%); NPV to 96-99% when the 99th percentile of the respective cTnI assay was combined with a copeptin level of 9 pmol/l (all p < 0.01). The incremental value in early presenters was similar to that of the overall cohort. Conclusion: When used for rapid rule-out of NSTEM in combination with sensitive or hs-cTnI assays, copeptin provides a numerically small, but statistically and likely also clinically significant incremental value. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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