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Ultra-sensitive Copeptin and cardiac Troponin in Diagnosing Non-ST-Elevation Acute Coronary Syndromes-the COPACS Study.
Am J Med. 2015 Jul 10;
Authors: Ricci F, Di Scala R, Massacesi C, Di Nicola M, Cremonese G, De Pace D, Rossi S, Griffo I, Cataldo I, Martinotti S, Rotondo D, Jaffe AS, Zimarino M, De Caterina R
Abstract
AIMS: We tested the non-inferiority of a fast-track rule-out protocol for the diagnosis of non-ST segment elevation myocardial infarction (NSTEMI) versus non-coronary chest pain based on the single-sampling combined assessment of medium sensitivity cardiac troponin I (ms-cTnI) and ultra-sensitive copeptin (us-Cop) compared with the serial assessment of ms-cTnI.
METHODS: Us-Cop and ms-cTnI levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute non-traumatic chest pain within 6 h from symptoms onset and without ST segment elevation on a 12-lead electrocardiogram. The diagnostic performance for NSTEMI diagnosis of the dual-marker single-sampling strategy with ms-cTnI and us-Cop on admission was compared to that of the serial 0 and 3-h ms-cTnI sampling in reference to the adjudicated post-discharge diagnosis, using both the comparison of areas under the Receiver Operating Characteristic (ROC) curve (AUC) and the McNemar chi-squared test.
RESULTS: The diagnosis of NSTEMI was adjudicated in 29 patients (14.8%). The combination of ms-cTnI and us-Cop generated an AUC of 0.87 (95% confidence interval (CI): 0.82 to 0.91), which was non-inferior with respect to the 3-h interval ms-cTnI serial sampling (P=0.194 for AUC difference). The combination of ms-cTnI and us-Cop also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; p=NS).
CONCLUSIONS: A single-sampling strategy of combined us-Cop and ms-cTnI is non-inferior to a 0 and 3-h serial ms-cTnI sampling in ruling-out NSTEMI, and may thus allow an earlier discharge of patients ruled out for NSTEMI (ClinicalTrials.gov Identifier NCT01962506).
PMID: 26169889 [PubMed - as supplied by publisher]