Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis

Abstract

Introduction: This study aimed to determine the diagnostic accuracy of adding copeptin to cardiac troponin (cTn) on admission to the emergency department (ED) for non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone.

Materials and methods: A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed (search date: April 13, 2018). Primary studies were included if they accurately reported on patients with symptoms suggestive of acute myocardial infarction and measured both cTn alone and cTn with copeptin upon admission to the ED. The patients with evidence of ST elevation myocardial infarction were excluded. To assess the risk of bias for the included studies, the QUADAS-2 tool was used.

Results: The study participants included a total of 7,998 patients from 14 observational studies. The addition of copeptin to cTn significantly improved the sensitivity (0.81 [0.74 to 0.87] vs. 0.92 [0.89 to 0.95], respectively, p <0.001) and negative predictive value (0.96 [0.95 to 0.98] vs. 0.98 [0.96 to 0.99], respectively, p <0.001) at the expense of lower specificity (0.88 [0.80 to 0.97] vs. 0.57 [0.49 to 0.65], respectively, p <0.001) compared to cTn alone. Furthermore, adding copeptin to cTn showed significantly lower diagnostic accuracy for NSTEMI compared to cTn alone (0.91[0.90 to 0.92] vs. 0.85 [0.83 to 0.86], respectively, p < 0.001).

Conclusions: Adding copeptin to cTn improved the sensitivity and negative predictive value for the diagnosis of NSTEMI compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the ED.

Fig 1. Flow diagram of study selection.

Fig 2. Coupled forest plot for the combined assessment of cardiac troponin and copeptin for NSTEMI.

Fig 3. Summary receiver operating characteristic curves for the assessment of cardiac troponin alone and cardiac troponin with copeptin for identifying of non-ST elevation myocardial infarction (14 studies).

(a) The pooled area under the curve for the assessment of cardiac troponin alone and cardiac troponin with copeptin are 0.91 and 0.85, respectively (p < 0.001). (b) For studies that assessed cardiac troponin I, the area under the curve scores for the assessment of cardiac troponin I alone and cardiac troponin I with copeptin are 0.93 and 0.80, respectively (p < 0.001). (c) When limited to studies assessing high-sensitivity cardiac troponin T, the area under the curve scores for the assessment of high-sensitivity cardiac troponin T alone and high-sensitivity cardiac troponin T with copeptin are 0.90 and 0.83, respectively, p < 0.001.