Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation. Issue 3 (24th March 2014)

• Record Type: Journal Article
• Authors: Duchenne, Jonathan; Mestres, Stéphanie; Dublanchet, Nicolas; Combaret, Nicolas; Marceau, Geoffroy; Caumon, Laurent; Dutoit, Laurent; Ughetto, Sylvie; Motreff, Pascal; Sapin, Vincent; Schmidt, Jeannot
• Other Names: Villemain Marc author non-byline.; Evrard Philippe author non-byline.; Philippe Jean-Marc author non-byline.; Perrier Christophe author non-byline.; Mathevon Thierry author non-byline.; André Benjamin author non-byline.; Billault Claire author non-byline.; Carrias Christine author non-byline.; Bailly-Glomot Nathalie author non-byline.; Lacroix Mathieu author non-byline.; Maurin Catherine author non-byline.; Moustafa Farès author non-byline.; Pic Daniel author non-byline.; Buisson Jean-Luc author non-byline.; Rougier Catherine author non-byline.; Tatulli Thomas author non-byline.; Tazé Sandrine author non-byline.; Dufraise Sébastien author non-byline.; Cueto Thierry author non-byline.; Dejou Christelle author non-byline.; Laporte Bruno author non-byline.; Luca Laura author non-byline.; Chouaki Mourad author non-byline.; Larroumets Guillaume author non-byline.; Nourrisson-Fage Célia author non-byline.; Ortigues Sylvain author non-byline.; Sureau Christophe author non-byline.; Weydenmeyer Guillaume author non-byline.; Bergzoll Stéphane author non-byline.; Raconnat Julien author non-byline.; Ponsoda Aurélien author non-byline.; Nguyen Guillaume author non-byline.; Font Manuel author non-byline.; Brès Marianne author non-byline.;
• Is Part Of: BMJ open. Volume 4:Issue 3(2014)
• Publication Date: 2014-03-24
• Subjects: Accident & Emergency Medicine; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2013-004449
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To determine whether copeptin-us can rule out diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) without prolonged monitoring and serial blood sampling in patients with high-sensitive cardiac troponin I (hs-cTnT) below the 99th centile at presentation to the emergency department (ED). Design: Prospective, non-randomised, individual blinded diagnostic accuracy study. Setting: Two EDs of a rural region of France. Participants: Patients with chest pain suspected of NSTEMI with onset within the last 12 h were considered for enrolment. Interventions: Serial clinical, electrographical and biochemical investigations were performed at admission and after 2, 4, 6 and 12 h. Hs-cTnT was measured using an assay with Dimension VISTA, Siemens. Copeptin was measured by the BRAHMS copeptin-us assay on the KRYPTOR Compact Plus system. The follow-up period was 90 days. Primary and secondary outcome measures: Copeptin, troponin, myoglobin and creatine kinase values. Clinical and paraclinical events. The final diagnosis was adjudicated blinded to copeptin result. Results: During 12 months, 102 patients were analysed. Final diagnosis was NSTEMI for 7.8% (n=8), unstable angina for 3.9% (n=4), cardiac but non-coronary artery disease for 8.8% (n=9), non-cardiac chest pain for 52% (n=53) and unknown for 27.5% (n=28). There was no statistical difference for copeptin values between patients with NSTEMI and others (respectively 5.5 pmol/L IQR (3.1–7.9) and 6.5 pmol/L IQR (3.9–12.1), p=0.49). Only one patient with NSTEMI had a copeptin value above the cut-off of 95th centile at admission. Conclusions: In this study, copeptin does not add a diagnostic value at admission to ED for patients with suspected acute coronary syndrome without ST-segment elevation and with hs-cTnT below the 99th centile. Trial registration number: Clinicaltrials.gov identifier: NCT01334645 .