Why the study?
Does a dual-marker strategy of copeptin and cardiac troponin improve diagnostic accuracy for rapid rule-out of acute myocardial infarction compared to cardiac troponin alone?
Does a dual-marker strategy of copeptin and cardiac troponin improve diagnostic accuracy for rapid rule-out of acute myocardial infarction compared to cardiac troponin alone?
Copeptin combined with conventional troponin improves the rapid rule-out of acute myocardial infarction, but adds little clinical value when high-sensitivity troponin assays are available.
Dual-marker copeptin-troponin testing may raise AMI rule-out NPV; leaves open prospective outcome trials before routine use.
Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care. However, the dual-marker approach seems to provide only very small incremental value when used in combination with sensitive or high-sensitivity cardiac troponin assays. This review aims to update and educate regarding the potential and the procedural details, as well as the caveats and challenges of using copeptin in clinical practice.
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Mueller et al. (2017) studied this question.
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