Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction
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Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction. / Zellweger, C.; Wildi, K.; Twerenbold, R.; Reichlin, T.; Naduvilekoot, A.; Neuhaus, J. D.; Balmelli, C.; Gabutti, M.; Afify, A. Al; Ballarino, P.; Jäger, C.; Druey, S.; Haaf, P.; Vilaplana, C.; Darbouret, B.; Ebmeyer, S.; Gimenez, M. Rubini; Moehring, B.; Osswald, S.; Mueller, C.
In: INT J CARDIOL, Vol. 190, No. 1, 01.08.2015, p. 190-197.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction
AU - Zellweger, C.
AU - Wildi, K.
AU - Twerenbold, R.
AU - Reichlin, T.
AU - Naduvilekoot, A.
AU - Neuhaus, J. D.
AU - Balmelli, C.
AU - Gabutti, M.
AU - Afify, A. Al
AU - Ballarino, P.
AU - Jäger, C.
AU - Druey, S.
AU - Haaf, P.
AU - Vilaplana, C.
AU - Darbouret, B.
AU - Ebmeyer, S.
AU - Gimenez, M. Rubini
AU - Moehring, B.
AU - Osswald, S.
AU - Mueller, C.
N1 - Publisher Copyright: © 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background: Diabetes is a major risk factor for acute myocardial infarction (AMI). Assessment of diabetic patients is challenging due to an often atypical presentation of symptoms. We aimed to evaluate the two novel biomarkers copeptin and high-sensitive cardiac troponin (hs-TnT) for the improvement of early diagnosis and risk-stratification in patients with diabetes and suspected AMI. Methods: In this prospective international multicenter study we evaluated 379 patients with diabetes in a cohort of 1991 patients presenting with symptoms suggestive of AMI. The measurement of biomarkers was performed at presentation. Results: Among the 379 diabetic patients, 32.7% had AMI, and in the 1621 patients without diabetes, 18.8% had AMI. The additional use of copeptin improved the diagnostic accuracy provided by conventional troponin alone (AUC 0.86 vs. 0.79, p = 0.004). During a median follow-up of 814 days, 49 (13.1%) diabetic patients died. Cumulative 2-year survival rate for patients with copeptin levels below 9 pmol/l was 96.6% compared to 82.8% in patients above that level (p < 0.001). The same was observed for hs-TnT with a cutoff level of 14 ng/l (97.7% vs. 82.0%, p < 0.001) respective of cTnT with a cutoff level of 10 ng/l (93.5% vs. 75.6%, p < 0.001). In multivariate Cox analysis, copeptin, hs-TnT and cTnT were strong and independent predictors of 24-month-mortality. Using the dual marker strategy (copeptin and troponin) identified two groups of high-risk patients where 22.5% of the group with hs-cTnT and copeptin above the cutoff and 28.6% with cTnT and copeptin above the cutoff died. Conclusion: In diabetic patients, copeptin only slightly improves the early diagnosis of AMI provided by hs-cTnT. However, both markers (copeptin and troponin) predict long-term mortality accurately and independently of each other.
AB - Background: Diabetes is a major risk factor for acute myocardial infarction (AMI). Assessment of diabetic patients is challenging due to an often atypical presentation of symptoms. We aimed to evaluate the two novel biomarkers copeptin and high-sensitive cardiac troponin (hs-TnT) for the improvement of early diagnosis and risk-stratification in patients with diabetes and suspected AMI. Methods: In this prospective international multicenter study we evaluated 379 patients with diabetes in a cohort of 1991 patients presenting with symptoms suggestive of AMI. The measurement of biomarkers was performed at presentation. Results: Among the 379 diabetic patients, 32.7% had AMI, and in the 1621 patients without diabetes, 18.8% had AMI. The additional use of copeptin improved the diagnostic accuracy provided by conventional troponin alone (AUC 0.86 vs. 0.79, p = 0.004). During a median follow-up of 814 days, 49 (13.1%) diabetic patients died. Cumulative 2-year survival rate for patients with copeptin levels below 9 pmol/l was 96.6% compared to 82.8% in patients above that level (p < 0.001). The same was observed for hs-TnT with a cutoff level of 14 ng/l (97.7% vs. 82.0%, p < 0.001) respective of cTnT with a cutoff level of 10 ng/l (93.5% vs. 75.6%, p < 0.001). In multivariate Cox analysis, copeptin, hs-TnT and cTnT were strong and independent predictors of 24-month-mortality. Using the dual marker strategy (copeptin and troponin) identified two groups of high-risk patients where 22.5% of the group with hs-cTnT and copeptin above the cutoff and 28.6% with cTnT and copeptin above the cutoff died. Conclusion: In diabetic patients, copeptin only slightly improves the early diagnosis of AMI provided by hs-cTnT. However, both markers (copeptin and troponin) predict long-term mortality accurately and independently of each other.
KW - Acute myocardial infarction
KW - Conventional cardiac troponin
KW - Copeptin
KW - Diabetes
KW - High sensitive cardiac troponin
UR - http://www.scopus.com/inward/record.url?scp=84929335430&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2015.04.134
DO - 10.1016/j.ijcard.2015.04.134
M3 - SCORING: Journal article
C2 - 25920022
AN - SCOPUS:84929335430
VL - 190
SP - 190
EP - 197
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
IS - 1
ER -
