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

TY - JOUR

T1 - Incremental value of copeptin to highly sensitive cardiac Troponin i for rapid rule-out of myocardial infarction

AU - Wildi, Karin

AU - Zellweger, Christa

AU - Twerenbold, Raphael

AU - Jaeger, Cedric

AU - Reichlin, Tobias

AU - Haaf, Philip

AU - Faoro, Jonathan

AU - Giménez, Maria Rubini

AU - Fischer, Andreas

AU - Nelles, Berit

AU - Druey, Sophie

AU - Krivoshei, Lian

AU - Hillinger, Petra

AU - Puelacher, Christian

AU - Herrmann, Thomas

AU - Campodarve, Isabel

AU - Rentsch, Katharina

AU - Steuer, Stephan

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Publisher Copyright: © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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 NSTEMIwas quantified using four outcomemeasures: area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), sensitivity and negative predictive value (NPV). Early presenters (b4 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 b 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 combinedwith a copeptin level of 9 pmol/l (all p b 0.01). The incremental value in early presenterswas 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.

AB - 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 NSTEMIwas quantified using four outcomemeasures: area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), sensitivity and negative predictive value (NPV). Early presenters (b4 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 b 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 combinedwith a copeptin level of 9 pmol/l (all p b 0.01). The incremental value in early presenterswas 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.

KW - Acute myocardial infarction

KW - Copeptin

KW - Highly sensitive Troponin I

KW - Sensitivity and specificity

UR - http://www.scopus.com/inward/record.url?scp=84929191797&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2015.04.133

DO - 10.1016/j.ijcard.2015.04.133

M3 - SCORING: Journal article

C2 - 25918073

AN - SCOPUS:84929191797

VL - 190

SP - 170

EP - 176

JO - INT J CARDIOL

JF - INT J CARDIOL

SN - 0167-5273

IS - 1

ER -