Copeptin plus troponin combo, accurate in ruling out acute myocardial infarction: Study

USA: In low-to-intermediate risk patients with the suspected acute coronary syndrome, combined negative copeptin and highly sensitive troponin testing resulted in a quick discharge from ICU, states an article published in the Heart Vessels.

 Most patients (≈85%) admitted to an emergency department (ED) with the possible acute coronary syndrome do not have an acute myocardial infarction (AMI). A critical and unmet therapeutic need for the prompt and reliable exclusion of acute myocardial infarction (AMI), resulting in the early discharge from the emergency department is required, as 2% to 5% of patients with AMI are discharged mistakenly from the ED, often with severe consequences.

High-sensitivity troponin (HS-TnT) combined with copeptin has been proposed to expedite the diagnostic exclusion of AMI in addition to its predictive usefulness in the intermediate and long-term outcomes of AMI. Global Registry of Acute Coronary Events (GRACE) is recommended as a prognostic score to manage acute coronary syndrome (ACS) without ST-segment elevation.

Sheref A. Elseidy, Rochester General Hospital, Rochester, USA, and colleagues conducted a systematic review to compare the diagnostic accuracy of HS-TnT combined with copeptin in ruling out AMI compared to HS-TnT alone.

Researchers included nine studies with a total of 13,232 participants for the review. They combined a low GRACE score (108) with negative HS-TnT (14 ng/L) and copeptin (14 pmol/L) to reliably rule out non-ST and ACS, including non-ST segment elevation MI and unstable angina.

Key findings of the review:

• The negative predictive value (NPV) for copeptin and HS-TnT was found to be slightly higher in combination (62–99%) than for HS-TnT alone (60–99%)

• The sensitivity of copeptin ranged from 0% to 100%, with a pooled sensitivity of 0.79.

• The specificity of copeptin ranged from 13% to 100%, with a pooled specificity of 0.89, a pooled positive likelihood ratio (PLR) of 9.86, and a pooled negative likelihood ratio (NLR) of 0.08.

The authors conclude that the use of combined negative copeptin and highly sensitive troponin testing in low-to-intermediate risk patients with suspected acute coronary syndrome results in a quick discharge with a safe and rapid rule-out non-ST and ACS.

Reference:

Elseidy, S.A., Awad, A.K., Mandal, D. et al. Copeptin plus troponin in the rapid rule out of acute myocardial infarction and prognostic value on post-myocardial infarction outcomes: a systematic review and diagnostic accuracy study. Heart Vessels (2022). https://doi.org/10.1007/s00380-022-02123-x