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

Written By : Dr. Hiral patel |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-07-12T20:00:02+05:30 | Updated On 12 July 2022 8:00 PM IST

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

Heart VesselscopeptinAcute coronary syndromeacute myocardial infarctiontroponin testing

Source : Heart Vessels

Dr. Hiral patel

BDS

Dr. Hiral patel (BDS) has completed BDS from Gujarat University, Baroda. She has worked in private dental steup for 8years and is currently a consulting general dentist in mumbai. She has recently completed her advanced PG diploma in clinical research and pharmacovigilance. She is passionate about writing and loves to read, analyses and write informative medical content for readers. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751