Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction
Standard
Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction : a systematic review and meta-analysis. / Raskovalova, Tatiana; Twerenbold, Raphael; Collinson, Paul O; Keller, Till; Bouvaist, Hélène; Folli, Christian; Giavarina, Davide; Lotze, Ulrich; Eggers, Kai M; Dupuy, Anne-Marie; Chenevier-Gobeaux, Camille; Meune, Christophe; Maisel, Alan; Mueller, Christian; Labarère, José.
in: EUR HEART J-ACUTE CA, Jahrgang 3, Nr. 1, 03.2014, S. 18-27.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction
T2 - a systematic review and meta-analysis
AU - Raskovalova, Tatiana
AU - Twerenbold, Raphael
AU - Collinson, Paul O
AU - Keller, Till
AU - Bouvaist, Hélène
AU - Folli, Christian
AU - Giavarina, Davide
AU - Lotze, Ulrich
AU - Eggers, Kai M
AU - Dupuy, Anne-Marie
AU - Chenevier-Gobeaux, Camille
AU - Meune, Christophe
AU - Maisel, Alan
AU - Mueller, Christian
AU - Labarère, José
PY - 2014/3
Y1 - 2014/3
N2 - AIMS: This systematic review aimed to investigate the diagnostic accuracy of combined cardiac troponin (cTn) and copeptin assessment in comparison to cTn alone for early rule-out of acute myocardial infarction (AMI).METHODS: Primary studies were eligible if they evaluated diagnostic accuracy for cTn with and without copeptin in patients with symptoms suggestive of AMI. AMI was defined according to the universal definition, using detection of cTn as a marker for myocardial necrosis. Eligible studies were identified by searching electronic databases (Medline, EMBASE, Science Citation Index Expanded, CINAHL, Pascal, and Cochrane) from inception to March 2013, reviewing conference proceedings and contacting field experts and the copeptin manufacturer.RESULTS: In 15 studies totalling 8740 patients (prevalence of AMI 16%), adding copeptin improved the sensitivity of cTn assays (from 0.87 to 0.96, p=0.003) at the expense of lower specificity (from 0.84 to 0.56, p<0.001). In 12 studies providing data for 6988 patients without ST-segment elevation, the summary sensitivity and specificity estimates were 0.95 (95% CI 0.89 to 0.98) and 0.57 (95% CI 0.49 to 0.65) for the combined assessment of cTn and copeptin. When a high-sensitivity cTnT assay was used in combination with copeptin, the summary sensitivity and specificity estimates were 0.98 (95% CI 0.96 to 1.00) and 0.50 (95% CI 0.42 to 0.58).CONCLUSION: Despite substantial between-study heterogeneity, this meta-analysis demonstrates that copeptin significantly improves baseline cTn sensitivity. Management studies are needed to establish the effectiveness and safety of measuring copeptin in combination with high-sensitivity cTnT for early rule-out of AMI without serial testing.
AB - AIMS: This systematic review aimed to investigate the diagnostic accuracy of combined cardiac troponin (cTn) and copeptin assessment in comparison to cTn alone for early rule-out of acute myocardial infarction (AMI).METHODS: Primary studies were eligible if they evaluated diagnostic accuracy for cTn with and without copeptin in patients with symptoms suggestive of AMI. AMI was defined according to the universal definition, using detection of cTn as a marker for myocardial necrosis. Eligible studies were identified by searching electronic databases (Medline, EMBASE, Science Citation Index Expanded, CINAHL, Pascal, and Cochrane) from inception to March 2013, reviewing conference proceedings and contacting field experts and the copeptin manufacturer.RESULTS: In 15 studies totalling 8740 patients (prevalence of AMI 16%), adding copeptin improved the sensitivity of cTn assays (from 0.87 to 0.96, p=0.003) at the expense of lower specificity (from 0.84 to 0.56, p<0.001). In 12 studies providing data for 6988 patients without ST-segment elevation, the summary sensitivity and specificity estimates were 0.95 (95% CI 0.89 to 0.98) and 0.57 (95% CI 0.49 to 0.65) for the combined assessment of cTn and copeptin. When a high-sensitivity cTnT assay was used in combination with copeptin, the summary sensitivity and specificity estimates were 0.98 (95% CI 0.96 to 1.00) and 0.50 (95% CI 0.42 to 0.58).CONCLUSION: Despite substantial between-study heterogeneity, this meta-analysis demonstrates that copeptin significantly improves baseline cTn sensitivity. Management studies are needed to establish the effectiveness and safety of measuring copeptin in combination with high-sensitivity cTnT for early rule-out of AMI without serial testing.
KW - Biomarkers/blood
KW - Diagnosis, Differential
KW - Glycopeptides/blood
KW - Humans
KW - Myocardial Infarction/blood
KW - Predictive Value of Tests
KW - Protein Precursors
KW - ROC Curve
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1177/2048872613514015
DO - 10.1177/2048872613514015
M3 - SCORING: Review article
C2 - 24562800
VL - 3
SP - 18
EP - 27
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 1
ER -
