Petra Hillinger1, Raphael Twerenbold1, Cedric Jaeger1, Karin Wildi1, Tobias Reichlin1, Maria Rubini Gimenez2, Ulrike Engels1, Oscar Miró3, Jasper Boeddinghaus1, Christian Puelacher1, Thomas Nestelberger1, Michèle Röthlisberger1, Susanne Ernst4, Katharina Rentsch5, Christian Mueller6. 1. Department of Cardiology and Cardiovascular Research Institute Basel and. 2. Department of Cardiology and Cardiovascular Research Institute Basel and Servicio de Urgencias, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; 3. Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain; Research Group "Emergencies: Processes and Pathologies," Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; 4. Department of Internal Medicine, Kantonsspital Olten, Switzerland. 5. Laboratory Medicine, University Hospital Basel, Switzerland; 6. Department of Cardiology and Cardiovascular Research Institute Basel and christian.mueller@usb.ch.
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. ClinicalTrials.gov/NCT00470587.
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. ClinicalTrials.gov/NCT00470587.
Authors: Lukasz Szarpak; Marcin Lapinski; Aleksandra Gasecka; Michal Pruc; Wiktoria L Drela; Mariusz Koda; Andrea Denegri; Frank W Peacock; Miłosz J Jaguszewski; Krzysztof J Filipiak Journal: J Cardiovasc Dev Dis Date: 2021-12-27
Authors: Evangelos Giannitsis; Stefan Blankenberg; Robert H Christenson; Norbert Frey; Stephan von Haehling; Christian W Hamm; Kenji Inoue; Hugo A Katus; Chien-Chang Lee; James McCord; Martin Möckel; Jack Tan Wei Chieh; Marco Tubaro; Kai C Wollert; Kurt Huber Journal: Clin Res Cardiol Date: 2021-02-26 Impact factor: 5.460