Combined testing of copeptin and high-sensitivity cardiac troponin T at presentation in comparison to other algorithms for rapid rule-out of acute myocardial infarction

• Verfasst von: Müller-Hennessen, Matthias [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Verfasst von: Vafaie, Mehrshad [VerfasserIn]
• Verfasst von: Biener, Moritz [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Titel: Combined testing of copeptin and high-sensitivity cardiac troponin T at presentation in comparison to other algorithms for rapid rule-out of acute myocardial infarction
• Verf.angabe: Matthias Mueller-Hennessen, Bertil Lindahl, Evangelos Giannitsis, Mehrshad Vafaie, Moritz Biener, Alexander C. Haushofer, Josef Seier, Michael Christ, Aitor Alquézar-Arbé, Christopher R. deFilippi, James McCord, Richard Body, Mauro Panteghini, Tomas Jernberg, Mario Plebani, Franck Verschuren, John K. French, Robert H. Christenson, Carina Dinkel, Hugo A. Katus, Christian Mueller, for the TRAPID-AMI investigators
• Jahr des Originals: 2018
• Umfang: 7 S.
• Fussnoten: Available online 26 October 2018 ; Gesehen am 19.02.2019
• Titel Quelle: Enthalten in: International journal of cardiology
• Jahr Quelle: 2019
• Band/Heft Quelle: 276(2019), S. 261-267
• ISSN Quelle: 1874-1754
• DOI: doi:10.1016/j.ijcard.2018.10.084
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1587791293

Abstract

Background We aimed to directly compare the diagnostic and prognostic performance of a dual maker strategy (DMS) with combined testing of copeptin and high-sensitivity (hs) cardiac troponin T (cTnT) it time of presentation with other algorithms for rapid rule-out of acute myocardial infarction (AMI). Methods 922 patients presenting to the emergency department with suspected AMI and available baseline copeptin measurements qualified for the present TRAPID-AMI substudy. Diagnostic measures using the DMS (copeptin <10, <14 or<20pmol/L and hs-cTnT≤14ng/L), the 1h-algorithm (hs-cTnT<12ng/L and change <3ng/L at 1h), as well as the hs-cTnT limit-of-blank (LoB, <3ng/L) and -detection (LoD, <5ng/L) were compared. Outcomes were assessed as combined end-points of death and myocardial re-infarction. Results True-negative rule-out using the DMS could be achieved in 50.9%-62.3% of all patients compared to 35.0%, 45.3% and 64.5% using LoB, LoD or the 1h-algorithm, respectively. The DMS showed NPVs of 98.1%-98.3% compared to 99.2% for the 1h-algorithm, 99.4% for the LoB and 99.3% for the LoD. Sensitivities were 93.5%-94.8%, as well as 96.8%, 98.7% and 98.1%, respectively. Addition of clinical low-risk criteria such as a HEART-score≤3 to the DMS resulted in NPVs and sensitivities of 100% with a true-negative rule-out to 33.8%-41.6%. Rates of the combined end-point of death/MI within 30days ranged between 0.2% and 0.3% for all fast-rule-out protocols. Conclusion Depending on the applied copeptin cut-off and addition of clinical low-risk criteria, the DMS might be an alternative to the hs-cTn-only-based algorithms for rapid AMI rule-out with comparable diagnostic measures and outcomes.