Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital

Background: The purpose of this observational study was to test the diagnostic performance of the Elecsys (R) troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI) in clinical practice. Methods: Troponin T high-sensitive (diagnostic cutoff:,14 pg/mL) and copeptin (diagnostic cutoff:,14 pmol/L) levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months. Results: Data from 142 consecutive patients (mean age 71.2 +/- 13.5 years, 76 men) were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2%) unstable angina pectoris in three (2.1%), cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%), and noncardiac disease in 47 patients (33.1%). The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (> 150 pmol/L), one of whom had a level of.700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of,14 pg/mL in combination with copeptin,14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%), each with a sensitivity and negative predictive value of 100%. Conclusion: According to this early experience, a single determination of troponin T highsensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.