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

Abstract

Background:The purpose of this observational study was to test the diagnostic performance of the Elecsys® troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI) in clinical practice.Methods:Troponin T high-sensitive (diagnostic cutoff: <14 pg/mL) and copeptin (diagnostic cutoff: <14 pmol/L) levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months.Results:Data from 142 consecutive patients (mean age 71.2 ± 13.5 years, 76 men) were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2%) unstable angina pectoris in three (2.1%), cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%), and noncardiac disease in 47 patients (33.1%). The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (>150 pmol/L), one of whom had a level of >700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of <14 pg/mL in combination with copeptin <14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%), each with a sensitivity and negative predictive value of 100%.Conclusion:According to this early experience, a single determination of troponin T high-sensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.

Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction

“…The temporal release pattern of copeptin in our study was characterized by increased values very early after symptom onset, a peak in ambulance or at admission, and a rapid decrease within the first hours after admission. Copeptin concentrations returned to baseline in all diagnoses after 12-36 h. Several studies have shown that copeptin values are increased in patients with AMI at admission, especially in early presenters (4,6,10,11,(17)(18)(19)(20)(21)(22)(23). We were able to illustrate for the first time that copeptin values were al- Thirty-five patients with AMI and SOT ≤180 min and 20 patients with AMI and SOT >180 min were included in this study.…”

Time from symptom onset influences high-sensitivity troponin T diagnostic accuracy for the diagnosis of acute myocardial infarction

“…Second, the ROC-derived cut-off values of hs-cTnT for AMI diagnosis were based on a high-risk population presenting with symptoms suggestive of AMI. The algorithm therefore requires confirmation and validation in a lower-risk cohort [24,25]. Third, we did not explore either a sex-specific cut-off value for the hs-cTnT assay, or the potential value Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 7/16/15 2:35 PM of dynamic change in hs-cTnT level as a diagnostic tool [26,27].…”

Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin

“…This evidence might be used as a (rule-in) warning to ED physicians regarding patients who need urgent triage and a more aggressive treatment. In fact, according to the signifi cant increase of copeptin in the individuals displaying a marked stress reaction, the emergency setting seems to be the ideal environment to fully exploit the information carried by the measurement of this marker and assess the risk for an acute life-threatening condition (85,86,88,92,93) .…”