Expeditious exclusion of acute coronary syndrome diagnosis by combined measurements of copeptin, high-sensitivity troponin, and GRACE score - 29/03/14
, Elophe Dubie, MD b, Claire Lebrun, MD c, Jérôme Jund, MD d, Gaspard Beaune, MD e, Patrick Lesage, MD b, Loïc Belle, MD f, Dominique Savary, MD aAbstract |
Background |
High-sensitivity troponin (HS-TnT) combined with copeptin have been proposed to expedite the diagnostic exclusion of acute myocardial infarction. The Global Registry of Acute Coronary Events (GRACE) has been validated and recommended by the European Society of Cardiology as a prognostic score in the management of acute coronary syndrome (ACS) without ST-segment elevation (non-ST+) on the electrocardiogram. Our study examined whether a low GRACE score (<108) combined with negative HS-TnT (<14 ng/L) and copeptin (<14 pmol/L) reliably exclude the diagnosis of non-ST+ ACS, including non–ST-segment elevation myocardial infarction and unstable angina.
Methods |
This observational, prospective study included patients presenting with chest pain lasting <6 hours, consistent with non-ST+ ACS. Blood was collected early for measurements of copeptin and HS-TnT. The negative predictive value of combined copeptin, HS-TnT, and GRACE score was calculated in the diagnosis of non-ST+ ACS. The thresholds of positivity were 14 ng/L for HS-TnT, 14 pmol/L for copeptin and 108 for the GRACE score.
Results |
Among 247 patients retained in the analysis, the diagnosis of ACS was made in 50 (20.4%), including 39 non–ST-segment elevation myocardial infarction and 11 unstable angina. The negative predictive value of combined HS-TnT, copeptin and GRACE score was 99%.
Conclusion |
A negative copeptin associated with a negative HS-TnT in a patient presenting with a low GRACE score expedited the diagnostic exclusion of non-ST+ ACS.
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| ☆ | This study was sponsored by B R A H M S Aktiengesellschaft, Part of Thermo Fisher Scientific Neuendorfstr. 25, 16761 Hennigsdorf, Allemagne. Tél.: +49 3302 883 0; Fax: +49 3302 883 100; e-mail: brahms@brahms.de. |
| ☆☆ | The preliminary results of this study were presented at the 2012 meetings of the French Society of Emergency Medicine and the French Society of Anesthesia and Intensive Care. |
Vol 32 - N° 4
P. 293-296 - avril 2014 Retour au numéro
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