Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes—The COPACS Study - 16/12/15
Abstract |
Objectives |
We tested the noninferiority of a fast-track rule-out protocol for the diagnosis of non-ST-segment elevation myocardial infarction vs noncoronary chest pain based on the single-sampling combined assessment of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin compared with the serial assessment of medium-sensitivity cardiac troponin I.
Methods |
Ultra-sensitive copeptin and medium-sensitivity cardiac troponin I levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute nontraumatic chest pain within 6 hours from symptoms onset and without ST-segment elevation on a 12-lead electrocardiogram. The diagnostic performance for non-ST-segment elevation myocardial infarction diagnosis of the dual-marker single-sampling strategy with medium-sensitivity cardiac troponin I and ultra-sensitive copeptin on admission was compared with that of the serial 0- and 3-hour medium-sensitivity cardiac troponin I sampling in reference to the adjudicated postdischarge diagnosis, using both the comparison of area under the curve (AUC) receiver operating characteristic and the McNemar chi-square test.
Results |
The diagnosis of non-ST-segment elevation myocardial infarction was adjudicated in 29 patients (14.8%). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin generated an AUC of 0.87 (95% confidence interval, 0.82-0.91), which was noninferior with respect to the 3-hour interval medium-sensitivity cardiac troponin I serial sampling (P = .194 for AUC difference). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; P = not significant).
Conclusions |
A single-sampling strategy of combined ultra-sensitive copeptin and medium-sensitivity cardiac troponin I is noninferior to a 0- and 3-hour serial medium-sensitivity cardiac troponin I sampling in ruling out non-ST-segment elevation myocardial infarction and thus may allow an earlier discharge of patients who are ruled out for non-ST-segment elevation myocardial infarction (ClinicalTrials.gov Identifier NCT01962506).
Le texte complet de cet article est disponible en PDF.Keywords : Biomarkers, Cardiac troponin, Copeptin, Early discharge, Emergency department, Myocardial infarction, Non–ST-segment elevation myocardial infarction
Plan
| Funding: The study was supported by institutional grants to the Institute of Cardiology, G. d'Annunzio University, Italy (to RDC). Copeptin assays were provided by Thermo Fisher Scientific Italy, through Dr Mary Lou Wratten and Dr Michele Anzelmo. |
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| Conflict of Interest: ASJ has in the past consulted or presently consults for most of the major biomarker diagnostic companies (Abbott Laboratories; Alere; Amgen Inc.; Beckman Coulter, Inc.; Critical Diagnostics; Radiometer Medical ApS.). |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 129 - N° 1
P. 105-114 - janvier 2016 Retour au numéro
Article précédent
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