The incremental value of copeptin with high-sensitivity troponin t for the early rule-out of acute myocardial infraction in the emergency department
S Bezati, C Verras, V Bistola, D Matsiras, E Kiouri, L Markos, A Diakantonis, I Ventoulis, E Polyzogopoulou, J ParissisAbstract
Background
Copeptin, a marker of endogenous stress, has been used for the early detection of patients with Acute Myocardial Infraction presenting to the Emergency Department (ED) with chest pain in combination with cardiac troponin, a marker of myocardial injury. Although its diagnostic value in conjunction with conventional troponin is well established, its additive value combined with high-sensitive troponin is not well defined.
Aim
To evaluate the diagnostic value of a dual marker strategy (DMS) consisting of copeptin in combination with high sensitive troponin T (hs-cTnT) measured upon ED presentation as compared with the recommended by the European Society of Cardiology (ESC) algorithms of hs-cTnT 0/1h and 0/2h for ruling-out Non-ST elevation Myocardial Infraction (NSTEMI).
Methods
In a double-blind prospective observational study, from September 2021 to October 2023, we enrolled 102 patients presenting to the ED because of chest pain of <6hours duration; patients with STEMI were excluded. In the total population (N=102), copeptin and hs-cTnT were measured upon patient presentation (time 0, DMS). Hs-cTnT was re-measured either on 1 hour (N=51) or 2 hours (N=51) after time 0. NSTEMI diagnosis was confirmed according to ESC guidelines. We compared the sensitivity, specificity, negative (NPV) and positive predictive value (PPV) of the DMS (using cut-offs for copeptin<10pmol/L and hs-cTnT<14ng/L) against the hs-TnT algorithms 0/1h and 0/2h for ruling-out NSTEMI.
Results
59.8% of the population were men, with a mean age of 76±18 years. 8.8% of patients were diagnosed with NSTEMI. The DMS demonstrated sensitivity 88.9% (95% CI: 51.75–99.72) and negative predictive value (NPV) 98.4% (90.92–99.76), while the hs-cTnT 0/1h algorithm showed sensitivity 60% (14.66–94.73) and NPV 95.6% (88.06–98.45) and the hs-cTnT 0/2h algorithm had sensitivity 75% (19.41–99.37) and NPV 95.8% (85.22–98.93).
Conclusion
The dual marker strategy has a comparable diagnostic accuracy to the ESC hs-cTnT 0/1h and 0/2h algorithms for the early rule-out of NSTEMI patients.Diagnostic accuracy of the DMSFor image description, please refer to the figure legend and surrounding text.