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Meta-Analysis
. 2014 Mar;3(1):18-27.
doi: 10.1177/2048872613514015. Epub 2013 Nov 20.

Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis

Tatiana Raskovalova  1 , Raphael Twerenbold, Paul O Collinson, Till Keller, Hélène Bouvaist, Christian Folli, Davide Giavarina, Ulrich Lotze, Kai M Eggers, Anne-Marie Dupuy, Camille Chenevier-Gobeaux, Christophe Meune, Alan Maisel, Christian Mueller, José Labarère
Affiliations
Meta-Analysis

Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis

Tatiana Raskovalova et al. Eur Heart J Acute Cardiovasc Care. 2014 Mar.

Abstract

Aims: This systematic review aimed to investigate the diagnostic accuracy of combined cardiac troponin (cTn) and copeptin assessment in comparison to cTn alone for early rule-out of acute myocardial infarction (AMI).

Methods: Primary studies were eligible if they evaluated diagnostic accuracy for cTn with and without copeptin in patients with symptoms suggestive of AMI. AMI was defined according to the universal definition, using detection of cTn as a marker for myocardial necrosis. Eligible studies were identified by searching electronic databases (Medline, EMBASE, Science Citation Index Expanded, CINAHL, Pascal, and Cochrane) from inception to March 2013, reviewing conference proceedings and contacting field experts and the copeptin manufacturer.

Results: In 15 studies totalling 8740 patients (prevalence of AMI 16%), adding copeptin improved the sensitivity of cTn assays (from 0.87 to 0.96, p=0.003) at the expense of lower specificity (from 0.84 to 0.56, p<0.001). In 12 studies providing data for 6988 patients without ST-segment elevation, the summary sensitivity and specificity estimates were 0.95 (95% CI 0.89 to 0.98) and 0.57 (95% CI 0.49 to 0.65) for the combined assessment of cTn and copeptin. When a high-sensitivity cTnT assay was used in combination with copeptin, the summary sensitivity and specificity estimates were 0.98 (95% CI 0.96 to 1.00) and 0.50 (95% CI 0.42 to 0.58).

Conclusion: Despite substantial between-study heterogeneity, this meta-analysis demonstrates that copeptin significantly improves baseline cTn sensitivity. Management studies are needed to establish the effectiveness and safety of measuring copeptin in combination with high-sensitivity cTnT for early rule-out of AMI without serial testing.

Keywords: copeptin; diagnostic accuracy; myocardial infarction; troponin.

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Conflict of interest statement

Conflict of interest: RT has received speaker honoraria from Brahms and Roche. TK has received speaker honoraria from Siemens Diagnostics and his institution has received grant support from Brahms and Abbott Diagnostics. DG has received research support from Thermo Fisher Scientific. KME has received honoraria from Roche Diagnostics and Siemens Healthcare Diagnostics and has served as a consultant for Abbott Laboratories. CC-G has received lecture fees from Roche Diagnostics. C Meune has received honoraria from Roche Diagnostics. AM has received consulting honoraria from Alere, BG Medicine, and Critical Diagnostics and has received research or speaking honoraria from BG Medicine, Abbott Laboratories, Alere, and Siemens Healthcare. C Mueller has received research support from Abbott Laboratories, Alere, Beckman Coulter, Brahms, Critical Diagnostics, Nanosphere, Roche Laboratories, Siemens Healthcare, and 8sense and has received speaker honoraria from Abbott Laboratories, Alere, Brahms, Novartis, Roche Laboratories, and Siemens Healthcare. The other authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Study selection.
Figure 2.
Figure 2.
Coupled Forest plot of sensitivity and specificity for the combined assessment of cardiac troponin and copeptin for early rule-out of acute myocardial infarction (15 studies). *Data were reported in Freund et al., 2012 (see supplementary data 2, available online).
Figure 3.
Figure 3.
Summary ROC curve for the assessment of cardiac troponin with and without copeptin for early rule-out of acute myocardial infarction (15 studies). The areas under the curve for the assessment of cardiac troponin without and with copeptin are 0.91 (95% CI 0.89 to 0.94) and 0.80 (95% CI 0.76 to 0.83), respectively.
See this image and copyright information in PMC

References

    1. Hamm CW, Bassand JP, 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. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551–2567 - PubMed
    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: 60–68 - PubMed
    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: 112–119 - PubMed
    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. - PMC - PubMed