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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, Vol. 61, No. 12, 12.2015, p. 1466-1474.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Hillinger, P, Twerenbold, R, Jaeger, C, Wildi, K, Reichlin, T, Gimenez, MR, Engels, U, Miró, O, Boeddinghaus, J, Puelacher, C, Nestelberger, T, Röthlisberger, M, Ernst, S, Rentsch, K & Mueller, C 2015, 'Optimizing early rule-out strategies for acute myocardial infarction: Utility of 1-hour copeptin', CLIN CHEM, vol. 61, no. 12, pp. 1466-1474. https://doi.org/10.1373/clinchem.2015.242743

APA

Hillinger, P., Twerenbold, R., Jaeger, C., Wildi, K., Reichlin, T., Gimenez, M. R., Engels, U., Miró, O., Boeddinghaus, J., Puelacher, C., Nestelberger, T., Röthlisberger, M., Ernst, S., Rentsch, K., & Mueller, C. (2015). Optimizing early rule-out strategies for acute myocardial infarction: Utility of 1-hour copeptin. CLIN CHEM, 61(12), 1466-1474. https://doi.org/10.1373/clinchem.2015.242743

Vancouver

Hillinger P, Twerenbold R, Jaeger C, Wildi K, Reichlin T, Gimenez MR et al. Optimizing early rule-out strategies for acute myocardial infarction: Utility of 1-hour copeptin. CLIN CHEM. 2015 Dec;61(12):1466-1474. https://doi.org/10.1373/clinchem.2015.242743

Bibtex

@article{b3d9b00c0edd4f17af7c690c0a9d2890,
title = "Optimizing early rule-out strategies for acute myocardial infarction: Utility of 1-hour copeptin",
abstract = "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.",
author = "Petra Hillinger and Raphael Twerenbold and Cedric Jaeger and Karin Wildi and Tobias Reichlin and Gimenez, {Maria Rubini} and Ulrike Engels and Oscar Mir{\'o} and Jasper Boeddinghaus and Christian Puelacher and Thomas Nestelberger and Mich{\`e}le R{\"o}thlisberger and Susanne Ernst and Katharina Rentsch and Christian Mueller",
note = "Publisher Copyright: {\textcopyright} 2015 American Association for Clinical Chemistry.",
year = "2015",
month = dec,
doi = "10.1373/clinchem.2015.242743",
language = "English",
volume = "61",
pages = "1466--1474",
journal = "CLIN CHEM",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "12",

}

RIS

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 -