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Incremental value of copeptin to high-sensitivity cardiac troponin T alone in the early diagnosis of acute myocardial infarction

Session Biomarkers and diagnosis of acute coronary syndrome in the emergency department

Speaker Raphael Twerenbold

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care
  • Session type : Rapid Fire Abstracts

Authors : R Twerenbold (Basel,CH), T Reichlin (Boston,US), M Rubini Gimenez (Basel,CH), C Jaeger (Basel,CH), Y Tanglay (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , T. Reichlin2 , M. Rubini Gimenez1 , C. Jaeger1 , Y. Tanglay1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland , 2Brigham and Women's Hospital, Department of Medicine, Cardiovascular Division - Boston - United States of America ,

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 885

Purpose: Recently, two novel approaches have shown to improve the early diagnosis of acute myocardial infarction (AMI): high-sensitivity cardiac troponin (hs-cTn) and copeptin, a sensitive marker of endogenous stress. It is unknown, whether the combination of hs-cTn and copeptin would further increase diagnostic accuracy.

Methods: In a prospective, international multicenter diagnostic study, copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in 1991 patients presenting to the emergency department with acute chest pain. The final diagnosis was centrally adjudicated by two independent cardiologists blinded for the investigational biomarkers.

Results: AMI was the adjudicated final diagnosis in 429 (22%) patients. The diagnostic accuracy for measurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve, did not differ significantly between the combination of hs-cTnT and copeptin (0.93; 95% confidence interval (CI) 0.92-0.94) as compared to hs-cTnT alone (0.93; 95% CI 0.92-0.94, p=0.076). The single use of hs-cTnT below the 99th percentile (14ng/l) resulted in a sensitivity of 90% and a negative predictive value of 97%. Using the dual marker strategy with copeptin resulted in a significant improvement with a sensitivity of 98% and a negative predictive value of 99% for hs-cTnT below the 99th percentile (14ng/l) and copeptin below 9pmol/l (p<0.001 for both comparisons).

Conclusions: The additional use of copeptin further improves the early rule-out of AMI in patients presenting with acute chest pain to the emergency department as compared to hs-cTnT alone. The additional use for the rule-in of AMI, however, seems limited.

Trial registration: ClinicalTrials.gov number, NCT00470587

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