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

Potocki, Mihael; Reichlin, Tobias; Thalmann, Simone; Zellweger, Christa; Twerenbold, Raphael; Reiter, Miriam; Steuer, Stephan; Bassetti, Stefano; Drexler, Beatrice; Stelzig, Claudia; Freese, Michael; Winkler, Katrin; Haaf, Philip; Balmelli, Cathrin; Hochholzer, Willibald; Oßwald, Stefan; Müeller, Christian

doi:10.1136/heartjnl-2011-301269

Cited by 69 publications

(57 citation statements)

References 42 publications

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“…17 We have previously reported that the combination of high sensitivity troponin T (hsTnT) and copeptin, a biomarker of endogenous stress, is helpful in the diagnostic process to rule out ACS. [10][11][12][13][14] Copeptin is the c-terminal of the vasopressin precursor hormone and is co-secreted with the hormone by the neurohypophysis as a response to endogenous stress. 14 One prospective study using the copeptintroponin algorithm has been presented with the results indicating this regimen to be a safe approach.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Examples of the proposed strategies are the use of hsTn in combination with a risk score, 4 the use of a second hsTn test analysed after 1 hour, 5 the use of undetectable hsTn levels [6][7][8][9] and the use of a combination of hsTn and another biomarker. [10][11][12][13][14][15][16] In older patients higher hsTn cut-off levels have been suggested to improve diagnostic performance. 17 We have previously reported that the combination of high sensitivity troponin T (hsTnT) and copeptin, a biomarker of endogenous stress, is helpful in the diagnostic process to rule out ACS.…”

Section: Introductionmentioning

confidence: 99%

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Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Thelin

Melander

Öhlin

2014

European Heart Journal: Acute Cardiovascular Care

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Aims: To examine whether undetectable high sensitivity troponin T (hsTnT) can be used to safely rule out non-STelevation acute coronary syndrome (NSTE-ACS) (using the limit of detection (LOD) as the cut-off) and to compare this strategy to serial hsTnT and the use of combined hsTnT and copeptin. Methods: In this prospective observational study, 478 patients presenting with chest pain were consecutively included. A combined primary endpoint of ACS, non-elective revascularization and/or death of all causes was used. The follow-up period was 60 days. Results: NSTE-ACS was diagnosed in 107 (22%) patients during hospital stay. Undetectable hsTnT at admission ruled out NSTE-ACS with a negative predictive value of 94% (95% confidence interval (CI): 88-97) giving a sensitivity of 0.90 (95% CI: 0.80-0.95) versus 0.78 (95% CI: 0.66-0.87) for serial hsTnT testing, p=0.008. The combination of hsTnT and copeptin analysed at admission resulted in a sensitivity of 0.83 (95% CI: 0.74-0.89), p=0.07 for comparison with undetectable hsTnT. Conclusion: A single hsTnT test at presentation, using the LOD as the cut-off, appears to be a safe and time-saving strategy to rule out NSTE-ACS. Further, undetectable levels of hsTnT were associated with an excellent prognosis and none of the patients with undetectable hsTnT were diagnosed with NSTEMI. Together with ECG and clinical assessment this biomarker strategy might permit outpatient treatment of almost one third of the patients we currently admit for observation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Thelin

Melander

Öhlin

2014

European Heart Journal: Acute Cardiovascular Care

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“…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.…”

Section: Discussionmentioning

confidence: 63%

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

Slagman¹,

Searle²,

Müller

et al. 2015

Clinical Chemistry

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BACKGROUND The release pattern of copeptin during the initial 36 h of spontaneous acute myocardial infarction (AMI) has received relatively little investigation but may provide important information on optimal timing of diagnostic measurements. METHODS We investigated the release pattern of copeptin and cardiac troponin T in patients with suspected acute coronary syndrome (ACS). Blood samples were collected in the ambulance, at admission, and after 2, 4, 6, and 12–36 h. Copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in heparin plasma samples. RESULTS Of 93 patients studied, 37 (39.8%) had ST-elevation myocardial infarction (STEMI), 20 (21.5%) non-STEMI, 20 (21.5%) unstable angina pectoris (UAP), and 16 (17.2%) non-ACS diagnoses. Peak copeptin concentrations were detected during ambulance transport for NSTEMI patients [median 94.0 pmol/L, interquartile range (IQR) 53.3–302.1 pmol/L] and at admission for patients with STEMI (70.0 pmol/L, 22.0–144.8 pmol/L). In patients with AMI, copeptin decreased significantly over time (P < 0.0001). This was true for patients with STEMI (P = 0.005) and non-STEMI (P = 0.021). The diagnostic performance during ambulance transport was similar for hs-cTnT (area under the ROC curve 0.75, 95% CI 0.62–0.88) and copeptin (0.81, 0.69–0.92). In early presenters (n = 52), no patient with AMI was initially (in ambulance or at admission) negative for copeptin, resulting in an area under the ROC curve of 0.963 for ambulance values and a negative predictive value of 100%. In late presenters, the negative predictive value of copeptin was 50% in ambulance and at admission. CONCLUSIONS Our analysis is the first to show a consistent early increase in copeptin at first medical contact in the ambulance and a decrease to routine values within 12–36 h in patients presenting early with spontaneous AMI.

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“…No study has yet been designed to analyze whether addition of copeptin to hs-cTn is superior to simply decreasing the cut-off of the hs-cTn assay. At least, post hoc analysis of the published ROC curves does not support superiority [23].…”

Section: This Issue Of Clinical Chemistry and Laboratory Medicinementioning

confidence: 99%

High-sensitivity assays for cardiac troponins

Lackner

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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(CCLM) devotes a large section to the cardiac troponins (cTn) and in particular to the impact of the novel high sensitivity (hs) assays on clinical practice. Furthermore, several articles deal with known or novel pitfalls of hs-cTn in clinical diagnostics.While there is no doubt that the hs-cTn assays constitute a significant analytical step forward, they obviously introduced a momentum of uncertainty for many clinicians. Perhaps this is common to all innovations which force people to leave their well known firm ground. In the case of hs-Tn the major changes relate to the rule-in and rule-out criteria of myocardial infarction. Already the first studies have provided robust data that early rule-out can be substantially improved and the ESC has adapted their guidelines accordingly [1][2][3]. However, many clinicians feel that rule-in has become more complicated not to say confusing. Since many of the traditional cTn assays had cut-offs far beyond the 99th percentile due to their relatively high limit of quantitation (LoQ) [4], the positive predictive value of an abnormal test result was high. In fact, it is important to keep in mind that the upper reference limit (URL) of most assays was not the 99th percentile but a significantly higher plasma concentration of cTn [4]. The novel hs-cTn assays provide reliable results between their 99th percentile and the cut-off of their predecessor tests [5]. This opens up a gray zone which was neglected in the past. Interpretation and clinical consequences derived from hs-cTn results in this gray zone are currently debated. For some but not all assays we have thorough data about positive and negative predictive values depending on individual patient characteristics and timing of cTn plasma concentrations [6]. Another issue that is profoundly influenced by the hs-cTn assays is the analysis of changes in cTn plasma concentrations over time and their diagnostic potential [7]. Many traditional cTn assays were not able to provide reliable time courses close to the 99th percentile. Therefore, the use of Δ-cTn generated with these assays was very limited. With the novel hs-cTn assays it is possible to reliably determine Δ-cTn even below the 99th percentile. However, the meaning of such changes is not clear and we will need more data from dedicated studies to interpret them [8][9][10].In order to better appreciate these problems, it is helpful to remember the reasons for the new definition of myocardial infarction introduced in the year 2000 [11]. In the past we tended to differentiate between stable angina, unstable angina, and myocardial infarction. In the 1990s it became clear that patients with unstable angina with elevated cTn concentration had the same risk of adverse outcomes as patients with what was then considered myocardial infarction, while patients without cTn elevations had a much better prognosis [12]. Interestingly, this subgroup of unstable angina patients also benefited from the same interventions as patients with myocardial infarction [13]. This observation finally l...

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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

Abstract: ClinicalTrials Gov number NCT00470587.

Cited by 69 publications

References 42 publications

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

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

High-sensitivity assays for cardiac troponins

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