Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset.

Stallone, Fabio; Schoenenberger, Andreas; Puelacher, Christian; Rubini Gimenez, Maria; Walz, Brigitte; Naduvilekoot Devasia, Allwin; Bergner, Michael; Twerenbold, Raphael; Wildi, Karin; Reichlin, Tobias; Hillinger, Petra; Erne, Paul; Müller, Christian (2016). Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset. European Heart Journal: Acute Cardiovascular Care, 5(5), pp. 407-415. Sage 10.1177/2048872616641289

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic

UniBE Contributor:

Schoenenberger, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2048-8734

Publisher:

Sage

Language:

English

Submitter:

Rebecca Rufer

Date Deposited:

16 May 2017 07:23

Last Modified:

16 May 2017 07:23

Publisher DOI:

10.1177/2048872616641289

PubMed ID:

27013743

Uncontrolled Keywords:

Acute myocardial infarction; copeptin; early diagnosis; early presenters

BORIS DOI:

10.7892/boris.95549

URI:

https://boris.unibe.ch/id/eprint/95549

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