Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

Jonathan Duchenne, Stéphanie Mestres, Nicolas Dublanchet, Nicolas Combaret, Geoffroy Marceau, Laurent Caumon, Laurent Dutoit, Sylvie Ughetto, Pascal Motreff, Vincent Sapin, Jeannot Schmidt, NSTEMI Study, Marc Villemain, Philippe Evrard, Jean-Marc Philippe, Christophe Perrier, Thierry Mathevon, Benjamin André, Claire Billault, Christine Carrias, Nathalie Bailly-Glomot, Mathieu Lacroix, Catherine Maurin, Farès Moustafa, Daniel Pic, Jean-Luc Buisson, Catherine Rougier, Thomas Tatulli, Sandrine Tazé, Sébastien Dufraise, Thierry Cueto, Christelle Dejou, Bruno Laporte, Laura Luca, Mourad Chouaki, Guillaume Larroumets, Célia Nourrisson-Fage, Sylvain Ortigues, Christophe Sureau, Guillaume Weydenmeyer, Stéphane Bergzoll, Julien Raconnat, Aurélien Ponsoda, Guillaume Nguyen, Manuel Font, Marianne Brès, Jonathan Duchenne, Stéphanie Mestres, Nicolas Dublanchet, Nicolas Combaret, Geoffroy Marceau, Laurent Caumon, Laurent Dutoit, Sylvie Ughetto, Pascal Motreff, Vincent Sapin, Jeannot Schmidt, NSTEMI Study, Marc Villemain, Philippe Evrard, Jean-Marc Philippe, Christophe Perrier, Thierry Mathevon, Benjamin André, Claire Billault, Christine Carrias, Nathalie Bailly-Glomot, Mathieu Lacroix, Catherine Maurin, Farès Moustafa, Daniel Pic, Jean-Luc Buisson, Catherine Rougier, Thomas Tatulli, Sandrine Tazé, Sébastien Dufraise, Thierry Cueto, Christelle Dejou, Bruno Laporte, Laura Luca, Mourad Chouaki, Guillaume Larroumets, Célia Nourrisson-Fage, Sylvain Ortigues, Christophe Sureau, Guillaume Weydenmeyer, Stéphane Bergzoll, Julien Raconnat, Aurélien Ponsoda, Guillaume Nguyen, Manuel Font, Marianne Brès

Abstract

Objective: To determine whether copeptin-us can rule out diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) without prolonged monitoring and serial blood sampling in patients with high-sensitive cardiac troponin I (hs-cTnI) below the 99th centile at presentation to the emergency department (ED) [corrected].

Design: Prospective, non-randomised, individual blinded diagnostic accuracy study.

Setting: Two EDs of a rural region of France.

Participants: Patients with chest pain suspected of NSTEMI with onset within the last 12 h were considered for enrollment.

Interventions: Serial clinical, electrographical and biochemical investigations were performed at admission and after 2, 4, 6 and 12 h. Hs-cTnI was measured using an assay with Dimension VISTA, Siemens [corrected]. Copeptin was measured by the BRAHMS copeptin-us assay on the KRYPTOR Compact Plus system. The follow-up period was 90 days.

Primary and secondary outcome measures: Copeptin, troponin, myoglobin and creatine kinase values. Clinical and paraclinical events. The final diagnosis was adjudicated blinded to copeptin result.

Results: During 12 months, 102 patients were analysed. Final diagnosis was NSTEMI for 7.8% (n=8), unstable angina for 3.9% (n=4), cardiac but non-coronary artery disease for 8.8% (n=9), non-cardiac chest pain for 52% (n=53) and unknown for 27.5% (n=28). There was no statistical difference for copeptin values between patients with NSTEMI and others (respectively 5.5 pmol/L IQR (3.1-7.9) and 6.5 pmol/L IQR (3.9-12.1), p=0.49). Only one patient with NSTEMI had a copeptin value above the cut-off of 95th centile at admission.

Conclusions: In this study, copeptin does not add a diagnostic value at admission to ED for patients with suspected acute coronary syndrome without ST-segment elevation and with hs-cTnI below the 99th centile [corrected].

Trial registration number: Clinicaltrials.gov identifier: NCT01334645.

Keywords: Accident & Emergency Medicine.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Box plots (median, IQR, minimal and maximal values) illustrate troponin, copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 3

Box plots (median, IQR, minimal…

Figure 3

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 3
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 4

Box plots (median, IQR, minimal…

Figure 4

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 4
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 5

Box plots (median, IQR, minimal…

Figure 5

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 5
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p
Similar articles
Cited by
References
    1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551–67 - PubMed
    1. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999–3054 - PubMed
    1. Lin S, Yokoyama H, Rac VE, et al. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation 2012;83:684–91 - PubMed
    1. Lippi G. Biomarkers of myocardial ischemia in the emergency room: cardiospecific troponin and beyond. Eur J Intern Med 2013;24:97–9 - PubMed
    1. Morgenthaler N, Struck J, Jochberger S. Copeptin: clinical use of a new biomarker. Trends Endocrinol Metab 2008;19:43–9 - PubMed
Show all 38 references
Associated data
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 3
Figure 3
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 4

Box plots (median, IQR, minimal…

Figure 4

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 4
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 5

Box plots (median, IQR, minimal…

Figure 5

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 5
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p
Similar articles
Cited by
References
    1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551–67 - PubMed
    1. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999–3054 - PubMed
    1. Lin S, Yokoyama H, Rac VE, et al. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation 2012;83:684–91 - PubMed
    1. Lippi G. Biomarkers of myocardial ischemia in the emergency room: cardiospecific troponin and beyond. Eur J Intern Med 2013;24:97–9 - PubMed
    1. Morgenthaler N, Struck J, Jochberger S. Copeptin: clinical use of a new biomarker. Trends Endocrinol Metab 2008;19:43–9 - PubMed
Show all 38 references
Associated data
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 4
Figure 4
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

Figure 5

Box plots (median, IQR, minimal…

Figure 5

Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and…

Figure 5
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p
Similar articles
Cited by
References
    1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551–67 - PubMed
    1. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999–3054 - PubMed
    1. Lin S, Yokoyama H, Rac VE, et al. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation 2012;83:684–91 - PubMed
    1. Lippi G. Biomarkers of myocardial ischemia in the emergency room: cardiospecific troponin and beyond. Eur J Intern Med 2013;24:97–9 - PubMed
    1. Morgenthaler N, Struck J, Jochberger S. Copeptin: clinical use of a new biomarker. Trends Endocrinol Metab 2008;19:43–9 - PubMed
Show all 38 references
Associated data
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5
Figure 5
Box plots (median, IQR, minimal and maximal values) illustrate Troponin, Copeptin, myoglobin and CK concentration in relation to time since admission for non-ST-segment elevation myocardial infarction (NSTEMI) and patients who are non-NSTEMI. *p

References

    1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551–67
    1. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999–3054
    1. Lin S, Yokoyama H, Rac VE, et al. Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review. Resuscitation 2012;83:684–91
    1. Lippi G. Biomarkers of myocardial ischemia in the emergency room: cardiospecific troponin and beyond. Eur J Intern Med 2013;24:97–9
    1. Morgenthaler N, Struck J, Jochberger S. Copeptin: clinical use of a new biomarker. Trends Endocrinol Metab 2008;19:43–9
    1. Morgenthaler NG, Struck J, Alonso C, et al. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem 2006;52:112–19
    1. Nickel CH, Bingisser R, Morgenthaler NG. The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department. BMC Med 2012;10:7.
    1. Lippi G, Plebani M, Di Somma S, et al. Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin. Clin Chem Lab Med 2012;50:243–53
    1. Reichlin T, Hochholzer W, Stelzig C, et al. Incremental value of copeptin for rapid rule out of acute myocardial infarction. J Am Coll Cardiol 2009;54:60–8
    1. Keller T, Tzikas S, Zeller T, et al. Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol 2010;55:2096–106
    1. Chenevier-Gobeaux C, Freund Y, Claessens Y-E, et al. Copeptin for rapid rule out of acute myocardial infarction in emergency department. Int J Cardiol 2013;166:198–204
    1. Meune C, Zuily S, Wahbi K, et al. Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: a pilot study. Arch Cardiovasc Dis 2011;104:4–10
    1. Karakas M, Januzzi JL, Meyer J, et al. Copeptin does not add diagnostic information to high-sensitivity troponin T in low- to intermediate-risk patients with acute chest pain: results from the rule out myocardial infarction by computed tomography (ROMICAT) study. Clin Chem 2011;57:1137–45
    1. Lotze U, Lemm H, Heyer A, et al. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital. Vasc Health Risk Manag 2011;7:509–15
    1. Giavarina D, Carta M, Fortunato A, et al. Copeptin and high sensitive troponin for a rapid rule out of acute myocardial infarction? Clin Lab 2011;57:725–30
    1. Giannitsis E, Kehayova T, Vafaie M, et al. Combined testing of high-sensitivity troponin T and copeptin on presentation at prespecified cutoffs improves rapid rule-out of non-ST-segment elevation myocardial infarction. Clin Chem 2011;57:1452–5
    1. Freund Y, Chenevier-Gobeaux C, Leumani F, et al. Concomitant measurement of copeptin and high sensitivity troponin for fast and reliable rule out of acute myocardial infarction. Ann Emerg Med 2011;58:S190
    1. Dupuy A-M, Chastang E, Cristol J-P, et al. Analytical performances of the newly developed, fully automated Kryptor Copeptin assay: which impact factor for myocardial infarction rules out in the emergency department? Clin Lab 2012;58:635–44
    1. Potocki M, Reichlin T, Thalmann S, et al. Diagnostic and prognostic impact of copeptin and high-sensitivity cardiac troponin T in patients with pre-existing coronary artery disease and suspected acute myocardial infarction. Heart 2012;98:558–65
    1. Ray P, Charpentier S, Chenevier-Gobeaux C, et al. Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease. Am J Emerg Med 2012;30:440–8
    1. Charpentier S, Maupas-Schwalm F, Cournot M, et al. Combination of copeptin and troponin assays to rapidly rule out non-ST elevation myocardial infarction in the emergency department. Acad Emerg Med 2012;19:517–24
    1. Eggers KM, Venge P, Lindahl B. High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain. Clin Chim Acta 2012;413:1135–40
    1. Folli C, Consonni D, Spessot M, et al. Diagnostic role of copeptin in patients presenting with chest pain in the emergency room. Eur J Intern Med 2013;24:189–93
    1. Dedic A, ten Kate GJ, Rood PP, et al. Copeptin in acute chest pain: identification of acute coronary syndrome and obstructive coronary artery disease on coronary CT angiography. Emerg Med J 2013;30:910–13
    1. Bahrmann P, Bahrmann A, Breithardt O-A, et al. Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department. Clin Chem Lab Med 2013;51:1307–19
    1. Ledochowski S, Fayet JM, Collin-Chavagnac D, et al. Évaluation de la copeptine dans les syndromes coronaires aigus non ST. Ann Fr Med Urgence 2013;3:138–44
    1. Maisel A, Mueller C, Neath S-X, et al. Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol 2013;62:150–60
    1. Charpentier S, Lepage B, Maupas-Schwalm F, et al. 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. Ann Emerg Med 2013;61:549–58e1
    1. Afzali D, Erren M, Pavenstädt HJ, et al. Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes. Clin Res Cardiol 2013;102:755–63
    1. Thelin J, Borna C, Erlinge D, et al. The combination of high sensitivity troponin T and copeptin facilitates early rule-out of ACS: a prospective observational study. BMC Cardiovasc Disord 2013;13:42.
    1. Sebbane M, Lefebvre S, Kuster N, et al. Early rule out of acute myocardial infarction in ED patients: value of combined high-sensitivity cardiac troponin T and ultrasensitive copeptin assays at admission. Am J Emerg Med 2013;31:1302–8
    1. Balmelli C, Meune C, Twerenbold R, et al. Comparison of the performances of cardiac troponins, including sensitive assays, and copeptin in the diagnostic of acute myocardial infarction and long-term prognosis between women and men. Am Heart J 2013;166:30–7
    1. Llorens P, Sánchez M, Herrero P, et al. The utility of copeptin in the emergency department for non-ST-elevation myocardial infarction rapid rule out: COPED-MIRRO study. Eur J Emerg Med 2013. Published Online First: 17 July 2013. doi:10.1097/MEJ.0b013 e3283632f8b.
    1. Collinson P, Gaze D, Goodacre S. Comparison of contemporary troponin assays with the novel biomarkers, heart fatty acid binding protein and copeptin, for the early confirmation or exclusion of myocardial infarction in patients presenting to the emergency department with chest pain. Heart 2014;100:140–5
    1. Sukul D, Bonaca MP, Ruff CT, et al. Diagnostic performance of copeptin in patients with acute nontraumatic chest pain: BWH-TIMI ED chest pain study. Clin Cardiol 2014. Published Online First: 22 January 2014. doi:.
    1. Kelly D, Squire IB, Khan SQ, et al. C-terminal provasopressin (copeptin) is associated with left ventricular dysfunction, remodeling and clinical heart failure in survivors of myocardial infarction. J Card Fail 2008;14:739–45
    1. Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012;33:2252–7
    1. Body R, Carley S, McDowell G, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 2011;58:1332–9

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する