Copeptin Improves the Diagnostic Performance of Sensitive Troponin I-Ultra but Cannot Rapidly Rule Out Non–ST-Elevation Myocardial Infarction at Presentation to an Emergency Department - 24/04/13
, Benoit Lepage, MD, PhD b, Françoise Maupas-Schwalm, MD, PhD c, d, Christel Cinq-Frais, MD c, Morgane Bichard-Bréaud, MD c, Jean Marie Botella, MD c, Meyer Elbaz, MD e, Dominique Lauque, MD a, f
Address for correspondence: Sandrine Charpentier, MD, PhDRésumé |
Study objective |
We assess the performance of a single multimarker strategy, using a combination of sensitive troponin I-Ultra and copeptin assays to rule out non–ST-elevation myocardial infarction (NSTEMI) at presentation to an emergency department (ED).
Methods |
A secondary analysis was carried out on 587 consecutive patients with chest pain who presented to the ED without ST elevation on ECG and were included in a single-site, prospective observational study. Samples for copeptin and combination of sensitive troponin I-Ultra assays were collected at presentation. The performance of the combination of copeptin and combination of sensitive troponin I-Ultra for NSTEMI was calculated in the whole cohort and after stratification by thrombosis in myocardial infarction (TIMI) risk score.
Results |
NSTEMI was diagnosed in 87 patients (14.8%). The sensitivity and the negative predictive value of the combination of copeptin and combination of sensitive troponin I-Ultra were 96.6% (95% confidence interval [CI] 90.3% to 99.3%) and 99.1% (95% CI 97.4% to 99.8%), respectively, for a cutoff level of copeptin less than 12 pmol/L. Among the 243 patients with a low TIMI score, all 8 who had an NSTEMI were detected with the combination (sensitivity 100%; 95% CI 63.1% to 100%), and 158 were a combination of sensitive troponin I-Ultra and copeptin negative and had no NSTEMI (negative predictive value 100%; 95% CI 97.7% to 100%).
Conclusion |
In this study, the combination of sensitive troponin and copeptin measurements had a high sensitivity and negative predictive value for NSTEMI diagnosis, especially among subjects with a low TIMI risk score. However, the sensitivity was too low to rule out NSTEMI with a single-draw strategy at ED presentation. Future studies are needed on the low-risk TIMI group to further investigate this preliminary finding.
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| Author contributions: SC, FM-S, ME, and DL conceived the study. SC, ME, and DL supervised the conduct of the trial and data collection, undertook recruitment of participating centers and patients, and managed the data, including quality control. FM-S, CCF, MBB, and JMB managed the biological data. SC and BL provided statistical advice on study design and analyzed data. SC drafted the article, and all authors contributed substantially to its revision. SC takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Charpentier has received speakers' fees from B·R·A·H·M·S Thermofisher, Roche Diagnostics, Astrazeneca, and Lilly Daiichi Sankyo. Dr. Elbaz has received speakers' fees from Bayer, Janssen-Cilag, Astrazeneca, St Jude Medical, Medtronic, and Lilly Daiichi Sankyo. For other authors: no conflict of interest. This work was supported by a grant from the Clinical Research Hospital Program of the French Ministry of Health (PHRC 2005) and was sponsored by the University Hospital of Toulouse for regulatory and ethic submissions (No. 02 016 01). B·R·A·H·M·S France provided a part of the investigational kits for the assays but had no role in the design of the study; the collection, analysis, and interpretation of the data; or the writing of the article. |
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| Please see page 550 for the Editor's Capsule Summary of this article. |
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| Supervising editor: Clare L. Atzema, MD, MSc |
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| Publication date: Available online March 5, 2013. |
Vol 61 - N° 5
P. 549 - mai 2013 Retour au numéro
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