Rapidly rule out acute myocardial infarction by combining copeptin and heart-type fatty acid-binding protein with cardiac troponin

Abstract

Background: The rapid exclusion of acute myocardial infarction in patients with chest pain can reduce the length of hospital admission, prevent unnecessary diagnostic work-up and reduce the burden on our health-care systems. The combined use of biomarkers that are associated with different pathophysiological aspects of acute myocardial infarction could improve the early diagnostic assessment of patients presenting with chest pain. Methods: We measured cardiac troponin I, copeptin and heart-type fatty acid-binding protein concentrations in 584 patients who presented to the emergency department with acute chest pain. The diagnostic performances for the diagnosis of acute myocardial infarction and NSTEMI were calculated for the individual markers and their combinations. Separate calculations were made for patients presenting to the emergency department <3 h, 3-6 h and 6-12 h after chest pain onset. Results: For ruling out acute myocardial infarction, the net predictive values (95% CI) of cardiac troponin I, copeptin and heart-type fatty acid-binding protein were 90.4% (87.3-92.9), 84% (79.8-87.6) and 87% (83.5-90), respectively. Combining the three biomarkers resulted in a net predictive value of 95.8% (92.8-97.8). The improvement was most pronounced in the early presenters (<3 h) where the combined net predictive value was 92.9% (87.3-96.5) compared to 84.6% (79.4-88.9) for cardiac troponin I alone. The area under the receiver operating characteristic for the triple biomarker combination increased significantly (P < 0.05) compared to that of cardiac troponin I alone (0.880 [0.833-0.928] vs. 0.840 [0.781-0.898], respectively). Conclusions: Combining copeptin, heart-type fatty acid-binding protein and cardiac troponin I measurements improves the diagnostic performance in patients presenting with chest pain. Importantly, in patients who present early (<3 h) after chest pain onset, the combination improves the diagnostic performance compared to the standard cardiac troponin I measurement alone.

Using expert elicitation to estimate the potential impact of improved diagnostic performance of laboratory tests: a case study on rapid discharge of suspected non–ST elevation myocardial infarction patients

“…Previous studies already investigated the diagnostic accuracy in excluding acute myocardial infarction using combinations of those markers. [26][27][28][29][30][31][32][33][34][35]49,63,64 However, this study is the first study that HsTn measurement costs about €9.55, indicating there is large headroom to achieve a cost-saving outcome.…”

“…In this paper, we illustrate the value of using expert elicitations in the early assessment of new medical tests, using a case of a triple biomarker to inform early exclusion of NSTEMI at the CPU. Previous studies already investigated the diagnostic accuracy in excluding acute myocardial infarction using combinations of those markers . However, this study is the first study that provides an initial estimate of the cost‐effectiveness of this triple biomarker in suspected NSTEMI patients on referral rates and on subsequent interventions.…”

“…As reported in previous studies, combining a HsTn measurement with other early cardiac markers might contribute to an early and safe discharge. [26][27][28][29][30][31][32][33][34][35] Two potential markers that are elevated rapidly after an acute myocardial infarction are copeptin and H-FABP. [36][37][38][39] Hence, adding those markers to the conventional HsTn measurement is expected to improve the overall diagnostic performance in the first hours after chest pain onset.…”

The use of biomarkers in detecting subclinical cardiotoxicity in doxorubicin-based treatment for paediatric patients with acute lymphoblastic leukaemia

“…It is a low molecular weight protein, found in the cytosol, and it has been more recently developed as cardiac biomarker [9,10,11]. It can be detected as soon as one hour after onset of ischemia and it can be seen as the earliest plasma marker available [12].…”

The clinical significance of copeptin and matrix metalloproteinases in men with acute coronary syndrome

“…Его концентрация, по данным литературы, повышается с 1-го часа инфаркта миокарда (ИМ), достигает пика в течение 6-8 ч; элевация сохраняется в течение 5 дней с последующим постепенным снижением до нормального уровня, что позволяет исключить наличие ИМ уже в ранние сроки [10,11]. По данным исследования LAMP, у пациентов с ИМ отмечается активация системы вазопрессина, а копептин является независимым от традиционных факторов риска предиктором смерти и развития сердечной недостаточности (СН) [7,12,13].…”