Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction.
Intensive Care Med. 2012 Feb 1;
Authors: Freund Y, Chenevier-Gobeaux C, Claessens YE, Leumani F, Doumenc B, Bonnet P, Allo JC, Cosson C, Riou B, Ray P
BACKGROUND: Newer assays (high-sensitivity troponin T, HsTnT) and biomarkers (copeptin) have recently improved the management of chest pain in the Emergency Department. OBJECTIVES: To assess the negative predictive value (NPV) of the combination of HsTnT and copeptin for the diagnosis of acute myocardial infarction (AMI). METHODS: In consecutive patients presenting at three emergency departments with chest pain (<6 h) suggestive of AMI, HsTnT and copeptin were measured at presentation, blinded to the emergency physicians. The medical management of patients was left to the discretion of the attending physicians according to the suspected diagnosis and the result of conventional troponin I (cTn I) assay. The discharge diagnosis was adjudicated by two independent experts using all available data. RESULTS: Three hundred seventeen patients were included. AMI was confirmed in 45 patients (14%), 13 had STEMI (ST elevation MI) and 32 NSTEMI (non-ST elevation MI). A copeptin level <10.7 pmol/l in combination with a HsTnT <0.014 ?g/l correctly ruled out AMI with a higher sensitivity than cTnI : 1.00 (95% confidence interval: [0.90-1.00]) versus 0.71 [0.55-0.84], p < 0.001. We also observed a significant gain in NPV: 1.00 [0.96-1.00] for copeptin + HsTnT versus 0.95 [0.92-0.97] for cTnI alone (p = 0.03). CONCLUSION: Copeptin in association with HsTnT is a fast and reliable tool to rule out AMI, with a sensitivity and NPV of 1.00 in our sample. Interventional studies are warranted to confirm these findings.
PMID: 22302027 [PubMed - as supplied by publisher]