Key result
Combining copeptin, heart-type fatty acid-binding protein, and cardiac troponin I significantly improved the diagnostic accuracy for acute myocardial infarction compared to troponin I alone (AUC 0.880 vs 0.840; P<0.05).
Why the study?
Does the combined measurement of copeptin, heart-type fatty acid-binding protein, and cardiac troponin I improve the diagnostic performance for ruling out acute myocardial infarction compared to cardiac troponin I alone in patients presenting to the emergency department with acute chest pain?
Cross-Sectional (n=584)
Does the combined measurement of copeptin, heart-type fatty acid-binding protein, and cardiac troponin I improve the diagnostic performance for ruling out acute myocardial infarction compared to cardiac troponin I alone in patients presenting to the emergency department with acute chest pain?
Combining copeptin, heart-type fatty acid-binding protein, and cardiac troponin I improves the early diagnostic exclusion of acute myocardial infarction in patients with chest pain, particularly in those presenting within 3 hours of symptom onset.
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.
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Jacobs et al. (2015) conducted a cross-sectional in Acute chest pain (n=584). Combination of copeptin, heart-type fatty acid-binding protein, and cardiac troponin I vs. Cardiac troponin I alone was evaluated on Area under the receiver operating characteristic curve for acute myocardial infarction (95% CI 0.833-0.928, p=<0.05). Combining copeptin, heart-type fatty acid-binding protein, and cardiac troponin I significantly improved the diagnostic accuracy for acute myocardial infarction compared to troponin I alone (AUC 0.880 vs 0.840; P<0.05).
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