Details

Autor(en) / Beteiligte

• Wildi, Karin
• Zellweger, Christa
• Twerenbold, Raphael
• Jaeger, Cedric
• Reichlin, Tobias
• Haaf, Philip
• Faoro, Jonathan
• Giménez, Maria Rubini
• Fischer, Andreas
• Nelles, Berit
• Druey, Sophie
• Krivoshei, Lian
• Hillinger, Petra
• Puelacher, Christian
• Herrmann, Thomas
• Campodarve, Isabel
• Rentsch, Katharina
• Steuer, Stephan
• Osswald, Stefan
• Mueller, Christian

Titel

Incremental value of copeptin to highly sensitive cardiac Troponin I for rapid rule-out of myocardial infarction

Ist Teil von

• International journal of cardiology, 2015-07, Vol.190, p.170-176

Ort / Verlag

Netherlands: Elsevier Ireland Ltd

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract 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.