Optimizing early rule-out strategies for acute myocardial infarction
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Optimizing early rule-out strategies for acute myocardial infarction : Utility of 1-hour copeptin. / Hillinger, Petra; Twerenbold, Raphael; Jaeger, Cedric; Wildi, Karin; Reichlin, Tobias; Gimenez, Maria Rubini; Engels, Ulrike; Miró, Oscar; Boeddinghaus, Jasper; Puelacher, Christian; Nestelberger, Thomas; Röthlisberger, Michèle; Ernst, Susanne; Rentsch, Katharina; Mueller, Christian.
in: CLIN CHEM, Jahrgang 61, Nr. 12, 12.2015, S. 1466-1474.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Optimizing early rule-out strategies for acute myocardial infarction
T2 - Utility of 1-hour copeptin
AU - Hillinger, Petra
AU - Twerenbold, Raphael
AU - Jaeger, Cedric
AU - Wildi, Karin
AU - Reichlin, Tobias
AU - Gimenez, Maria Rubini
AU - Engels, Ulrike
AU - Miró, Oscar
AU - Boeddinghaus, Jasper
AU - Puelacher, Christian
AU - Nestelberger, Thomas
AU - Röthlisberger, Michèle
AU - Ernst, Susanne
AU - Rentsch, Katharina
AU - Mueller, Christian
N1 - Publisher Copyright: © 2015 American Association for Clinical Chemistry.
PY - 2015/12
Y1 - 2015/12
N2 - BACKGROUND: Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high - although still imperfect - negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV. METHODS: In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive). RESULTS: The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%-99.7%, P < 0.001). CONCLUSIONS: One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings.
AB - BACKGROUND: Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high - although still imperfect - negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV. METHODS: In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive). RESULTS: The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%-99.7%, P < 0.001). CONCLUSIONS: One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings.
UR - http://www.scopus.com/inward/record.url?scp=84948698480&partnerID=8YFLogxK
U2 - 10.1373/clinchem.2015.242743
DO - 10.1373/clinchem.2015.242743
M3 - SCORING: Journal article
C2 - 26323282
AN - SCOPUS:84948698480
VL - 61
SP - 1466
EP - 1474
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 12
ER -