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. 2014 Mar 24;4(3):e004449.
doi: 10.1136/bmjopen-2013-004449.

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  1 , Stéphanie Mestres, Nicolas Dublanchet, Nicolas Combaret, Geoffroy Marceau, Laurent Caumon, Laurent Dutoit, Sylvie Ughetto, Pascal Motreff, Vincent Sapin, Jeannot Schmidt; NSTEMI Study
Collaborators, Affiliations

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 et al. BMJ Open. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] BMJ Open. 2014 Apr 9;4(4):e004449corr1. doi: 10.1136/bmjopen-2013-004449corr1. BMJ Open. 2014. PMID: 24719432 Free PMC article. No abstract available.

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.

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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<0.0001, **p=0.01, ***p=0.04, ****p=0.03. Hs-cTnT, high-sensitive cardiac troponin I.
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<0.0001, **p=0.01, ***p=0.04, ****p=0.03.
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<0.0001, **p=0.01, ***p=0.04, ****p=0.03.
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<0.0001, **p=0.01, ***p=0.04, ****p=0.03.
See this image and copyright information in PMC

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

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