Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset
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Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset. / Stallone, Fabio; Schoenenberger, Andreas W; Puelacher, Christian; Rubini Gimenez, Maria; Walz, Brigitte; Naduvilekoot Devasia, Allwin; Bergner, Michael; Twerenbold, Raphael; Wildi, Karin; Reichlin, Tobias; Hillinger, Petra; Erne, Paul; Mueller, Christian.
In: EUR HEART J-ACUTE CA, Vol. 5, No. 5, 09.2016, p. 407-415.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset
AU - Stallone, Fabio
AU - Schoenenberger, Andreas W
AU - Puelacher, Christian
AU - Rubini Gimenez, Maria
AU - Walz, Brigitte
AU - Naduvilekoot Devasia, Allwin
AU - Bergner, Michael
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Reichlin, Tobias
AU - Hillinger, Petra
AU - Erne, Paul
AU - Mueller, Christian
N1 - © The European Society of Cardiology 2016.
PY - 2016/9
Y1 - 2016/9
N2 - BACKGROUND: Patients presenting very early after chest pain onset may provide a diagnostic challenge even when using a high-sensitivity cardiac troponin (hs-cTnT). We hypothesized that in these patients the incremental value of copeptin in the early diagnosis of acute myocardial infarction (AMI) may be substantial.METHODS: We aimed to investigate the incremental value of copeptin in a pre-specified subgroup analysis of patients presenting with suspected AMI to the emergency department within 2 hours of symptom onset in a multicenter study. Copeptin was measured in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis using all available clinical informations, including high-sensitivity cardiac troponin T (hs-cTnT).RESULTS: Overall, 2000 patients were enrolled, of whom 519 (26%) arrived within 2 hours of symptom onset. Of these, 102 patients (20%) had an AMI. The additional use of copeptin did not increase diagnostic accuracy as quantified by the area under the receiver-operating characteristic curve (AUC) of hs-cTnT (0.87 (95% confidence interval (CI): 0.83-0.90) for hs-cTnT alone to 0.86 (95% CI: 0.82-0.90) for the combination; p = NS). Copeptin (using 9 pmol/L as a cut-off) increased the negative predictive value (NPV) of hs-cTnT (using 14 ng/L as a cut-off) alone from 93% (95% CI: 90-95%) to 96% (95% CI: 93-98%). The NPV for the combination of hs-cTnT and copeptin was lower in patients arriving in the first 2 hours than in those arriving after 2 hours: 96% (95% CI: 93-98%) versus 99% (95% CI: 99-100%), respectively.CONCLUSIONS: The additional use of copeptin on top of hs-cTnT seems to lead to a small increase in NPV, but no increase in AUC. Routine use of copeptin in early presenters does not seem warranted.
AB - BACKGROUND: Patients presenting very early after chest pain onset may provide a diagnostic challenge even when using a high-sensitivity cardiac troponin (hs-cTnT). We hypothesized that in these patients the incremental value of copeptin in the early diagnosis of acute myocardial infarction (AMI) may be substantial.METHODS: We aimed to investigate the incremental value of copeptin in a pre-specified subgroup analysis of patients presenting with suspected AMI to the emergency department within 2 hours of symptom onset in a multicenter study. Copeptin was measured in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis using all available clinical informations, including high-sensitivity cardiac troponin T (hs-cTnT).RESULTS: Overall, 2000 patients were enrolled, of whom 519 (26%) arrived within 2 hours of symptom onset. Of these, 102 patients (20%) had an AMI. The additional use of copeptin did not increase diagnostic accuracy as quantified by the area under the receiver-operating characteristic curve (AUC) of hs-cTnT (0.87 (95% confidence interval (CI): 0.83-0.90) for hs-cTnT alone to 0.86 (95% CI: 0.82-0.90) for the combination; p = NS). Copeptin (using 9 pmol/L as a cut-off) increased the negative predictive value (NPV) of hs-cTnT (using 14 ng/L as a cut-off) alone from 93% (95% CI: 90-95%) to 96% (95% CI: 93-98%). The NPV for the combination of hs-cTnT and copeptin was lower in patients arriving in the first 2 hours than in those arriving after 2 hours: 96% (95% CI: 93-98%) versus 99% (95% CI: 99-100%), respectively.CONCLUSIONS: The additional use of copeptin on top of hs-cTnT seems to lead to a small increase in NPV, but no increase in AUC. Routine use of copeptin in early presenters does not seem warranted.
KW - Aged
KW - Early Diagnosis
KW - Female
KW - Glycopeptides/metabolism
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Predictive Value of Tests
KW - Prospective Studies
KW - ROC Curve
U2 - 10.1177/2048872616641289
DO - 10.1177/2048872616641289
M3 - SCORING: Journal article
C2 - 27013743
VL - 5
SP - 407
EP - 415
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 5
ER -
