Diagnostic and prognostic impact of copeptin and high-sensitivity cardiac troponin T in patients with pre-existing coronary artery disease and suspected acute myocardial infarction
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Diagnostic and prognostic impact of copeptin and high-sensitivity cardiac troponin T in patients with pre-existing coronary artery disease and suspected acute myocardial infarction. / Potocki, Mihael; Reichlin, Tobias; Thalmann, Simone; Zellweger, Christa; Twerenbold, Raphael; Reiter, Miriam; Steuer, Stephan; Bassetti, Stefano; Drexler, Beatrice; Stelzig, Claudia; Freese, Michael; Winkler, Katrin; Haaf, Philip; Balmelli, Cathrin; Hochholzer, Willibald; Osswald, Stefan; Mueller, Christian.
In: HEART, Vol. 98, No. 7, 04.2012, p. 558-565.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diagnostic and prognostic impact of copeptin and high-sensitivity cardiac troponin T in patients with pre-existing coronary artery disease and suspected acute myocardial infarction
AU - Potocki, Mihael
AU - Reichlin, Tobias
AU - Thalmann, Simone
AU - Zellweger, Christa
AU - Twerenbold, Raphael
AU - Reiter, Miriam
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Drexler, Beatrice
AU - Stelzig, Claudia
AU - Freese, Michael
AU - Winkler, Katrin
AU - Haaf, Philip
AU - Balmelli, Cathrin
AU - Hochholzer, Willibald
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2012/4
Y1 - 2012/4
N2 - Objective: The early diagnosis of acute myocardial infarction (AMI) can be particularly challenging in patients with known coronary artery disease (CAD) due to pre-existing ECG changes and chronic increases in cardiac troponin (cTn) levels. Design: Of 1170 consecutive patients presenting with symptoms suggestive of AMI, 433 (37%) with pre-existing CAD were analysed in a prospective multicentre study and the diagnostic and prognostic impact of copeptin in combination with either fourth generation cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT) was evaluated. Results: AMI was the final diagnosis in 78 patients with pre-existing CAD (18%). Copeptin was significantly higher in patients with AMI than in those without (26 pmol/l (IQR 9-71) vs 7 pmol/l (IQR 4e16), p<0.001). The diagnostic accuracy for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was significantly higher for the combination of copeptin and cTnT than for cTnT alone (0.94 vs 0.86, p<0.001). The combination of copeptin and hs-cTnT (0.94) was trending to superiority compared with hs-cTnT alone (0.92, p=0.11). The combination of copeptin and the cTn assays was able to improve the negative predictive value up to 99.5% to rule out AMI. Copeptin was a strong and independent predictor of 1-year mortality (HR 4.18-4.63). Irrespective of cTn levels, patients with low levels of copeptin had an excellent prognosis compared with patients with raised levels of both copeptin and cTn (360-day mortality 2.8-3.6% vs 23.1-33.8%, p<0.001). Conclusion: In patients with pre-existing CAD, copeptin significantly improves the diagnostic accuracy if used in addition to cTnT, but only trended to superiority compared with hs-cTnT alone. Copeptin provides independent prognostic information, largely by overcoming the challenging interpretation of mild increases in hs-cTnT. Clinical trial registration number: ClinicalTrials Gov number NCT00470587.
AB - Objective: The early diagnosis of acute myocardial infarction (AMI) can be particularly challenging in patients with known coronary artery disease (CAD) due to pre-existing ECG changes and chronic increases in cardiac troponin (cTn) levels. Design: Of 1170 consecutive patients presenting with symptoms suggestive of AMI, 433 (37%) with pre-existing CAD were analysed in a prospective multicentre study and the diagnostic and prognostic impact of copeptin in combination with either fourth generation cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT) was evaluated. Results: AMI was the final diagnosis in 78 patients with pre-existing CAD (18%). Copeptin was significantly higher in patients with AMI than in those without (26 pmol/l (IQR 9-71) vs 7 pmol/l (IQR 4e16), p<0.001). The diagnostic accuracy for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was significantly higher for the combination of copeptin and cTnT than for cTnT alone (0.94 vs 0.86, p<0.001). The combination of copeptin and hs-cTnT (0.94) was trending to superiority compared with hs-cTnT alone (0.92, p=0.11). The combination of copeptin and the cTn assays was able to improve the negative predictive value up to 99.5% to rule out AMI. Copeptin was a strong and independent predictor of 1-year mortality (HR 4.18-4.63). Irrespective of cTn levels, patients with low levels of copeptin had an excellent prognosis compared with patients with raised levels of both copeptin and cTn (360-day mortality 2.8-3.6% vs 23.1-33.8%, p<0.001). Conclusion: In patients with pre-existing CAD, copeptin significantly improves the diagnostic accuracy if used in addition to cTnT, but only trended to superiority compared with hs-cTnT alone. Copeptin provides independent prognostic information, largely by overcoming the challenging interpretation of mild increases in hs-cTnT. Clinical trial registration number: ClinicalTrials Gov number NCT00470587.
UR - http://www.scopus.com/inward/record.url?scp=84858618064&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2011-301269
DO - 10.1136/heartjnl-2011-301269
M3 - SCORING: Journal article
C2 - 22337952
AN - SCOPUS:84858618064
VL - 98
SP - 558
EP - 565
JO - HEART
JF - HEART
SN - 1355-6037
IS - 7
ER -
