Optimizing Early Rule-Out Strategies for Acute Myocardial Infarction: Utility of 1-Hour Copeptin

Clinical Chemistry
Petra HillingerChristian Mueller

Abstract

Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high-although still imperfect-negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV. In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive). The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly...Continue Reading

Associated Clinical Trials

References

Apr 20, 2000·The New England Journal of Medicine·J H PopeH P Selker
Oct 3, 2002·Seminars in Liver Disease·R Brian Doctor, Laura Fouassier
Nov 5, 2005·Clinical Chemistry·Nils G MorgenthalerAndreas Bergmann
Oct 13, 2006·European Journal of Clinical Investigation·B StoiserR Pacher
Oct 24, 2007·European Heart Journal·Kristian ThygesenUNKNOWN Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
Jun 28, 2008·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Manish N ShahBruce Friedman
Jun 27, 2009·Journal of the American College of Cardiology·Tobias ReichlinChristian Mueller
Aug 28, 2009·The New England Journal of Medicine·Tobias ReichlinChristian Mueller
Aug 28, 2009·The New England Journal of Medicine·Till KellerStefan Blankenberg
Dec 5, 2009·Clinical Chemistry·Evangelos GiannitsisHugo A Katus
Dec 26, 2009·Annals of Neurology·Mira KatanMirjam Christ-Crain
May 8, 2010·Journal of the American College of Cardiology·Till KellerStefan Blankenberg
May 18, 2010·Clinical Chemistry·Vlad C VasileAllan S Jaffe
Jul 19, 2011·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Youlan L GuBart J G L de Smet
Mar 6, 2012·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Martin MockelRajan Somasundaram
Jun 23, 2012·European Heart Journal·Kristian ThygesenUNKNOWN Study Group on Biomarkers in Cardiology of ESC Working Group on Acute Cardiac Care
Aug 16, 2012·Archives of Internal Medicine·Tobias ReichlinChristian Mueller
Aug 28, 2012·European Heart Journal·Kristian ThygesenUNKNOWN ESC Committee for Practice Guidelines (CPG)
Aug 28, 2012·European Heart Journal·UNKNOWN Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)Doron Zahger
Apr 4, 2014·Journal of the American College of Cardiology·Nadia BandsteinMartin J Holzmann

❮ Previous
Next ❯

Citations

May 2, 2017·Critical Reviews in Clinical Laboratory Sciences·Marek KozinskiGrazyna Sypniewska
Jun 9, 2017·European Heart Journal. Acute Cardiovascular Care·Christian MuellerUNKNOWN ESC Study Group on Biomarkers in Cardiology of the Acute Cardiovascular Care Association
Oct 28, 2015·Clinical Chemistry·Benjamin M Scirica, David A Morrow
Aug 30, 2020·European Heart Journal·Jean-Philippe ColletUNKNOWN ESC Scientific Document Group
Nov 12, 2020·Biomarkers : Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals·Martin Möckel
Feb 27, 2021·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Evangelos GiannitsisKurt Huber

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.