The combination of high sensitivity troponin T and copeptin at admission identified acute coronary syndrome with a significantly higher sensitivity (83%) compared to high sensitivity troponin T alone (69%).
Observational (n=478)
No
Does the combination of high sensitivity troponin T and copeptin at admission improve the diagnostic sensitivity for acute coronary syndrome compared to high sensitivity troponin T alone in patients presenting with chest pain?
The combination of high sensitivity troponin T and copeptin at admission significantly increases the sensitivity for diagnosing acute coronary syndrome compared to troponin alone, potentially facilitating earlier risk stratification and rule-out in chest pain patients.
Absolute Event Rate: 0.83% vs 0.69%
p-value: p=<0.001
The combination of the new high sensitivity troponin T (hsTnT) assays and copeptin, a biomarker of endogenous stress, has been suggested to have the potential of early rule-out of acute coronary syndrome (ACS). The aim of this study was to examine the ability of this combination to rule out ACS in patients presenting with chest pain and to compare the diagnostic performance to hsTnT alone. In this prospective observational study, patients with chest pain admitted for observation were consecutively included. Patients presenting with ST elevation were excluded. Copeptin and hsTnT were analyzed at admission and hsTnT was thereafter determined approximately every 3rd hour as long as clinically indicated. The follow-up period was 60 days. A combined primary endpoint of ACS, non-elective percutanous coronary intervention, non-elective coronary artery bypass surgery and death of all causes was used. 478 patients were included. 107 (22%) patients were diagnosed with ACS during hospital stay. 70 (14%) had non-ST-segment elevation myocardial infarction (NSTEMI) and 37 (8%) had unstable angina pectoris (UAP). The combination of hsTnT >14 ng/L or copeptin ≥14 pmol/L at admission identified ACS with a higher sensitivity than hsTnT alone: 0.83 (95% confidence interval (CI): 0.74-0.89) versus 0.69 (95% CI: 0.59-0.77), p <0.001. Negative predictive values (NPV) 91% (95% CI: 86-94) versus 89% (95% CI: 84-92). A repeated hsTnT analyzed 3-4 hours after admission resulted in a sensitivity of: 0.77 (95% CI: 0.65-0.86), p =0.031 for comparison with the combination analyzed at admission. In patients presenting with chest pain admitted for observation, the combination of hsTnT and copeptin analyzed at admission had a significantly higher sensitivity to diagnose ACS than hsTnT alone. We report a sensitivity of 83% and a NPV of 91% for the combination of hsTnT and copeptin and we conclude that biomarkers alone are not sufficient to rule out ACS. However, the combination of hsTnT and copeptin seems to have a significantly higher sensitivity to identify ACS than a repeated hsTnT test, and thus enables an earlier risk stratification of chest pain patients. This can be time-saving and beneficial for the individual patient by contributing to early decisions on treatment, need of further assessment and level of care.
Thelin et al. (Tue,) conducted a observational in Suspected acute coronary syndrome (n=478). Combination of high sensitivity troponin T and copeptin vs. High sensitivity troponin T alone was evaluated on Sensitivity to identify acute coronary syndrome at admission (p=<0.001). The combination of high sensitivity troponin T and copeptin at admission identified acute coronary syndrome with a significantly higher sensitivity (83%) compared to high sensitivity troponin T alone (69%).