Cardiology Department, hôpital Cochin, AP-HP, université Paris Descartes, Paris cedex 14, France.
Arch Cardiovasc Dis. 2011 Jan;104(1):4-10. doi: 10.1016/j.acvd.2010.11.002. Epub 2010 Dec 22.
High-sensitivity cardiac troponin assays have improved the detection of acute coronary syndrome.
To examine the possible incremental value of copeptin in the detection of acute coronary syndrome.
We designed a prospective cohort study to compare the performance of high-sensitivity cardiac troponin T (hs-cTnT) measured at admission in combination with copeptin, and the performance of hs-cTnT alone, measured at admission, 3 hours and 6 hours, in patients with suspected acute coronary syndrome of < 6 hours' duration after onset of symptoms (exclusion of patients with ST-segment elevation myocardial infarction).
Fifty-eight consecutive patients fulfilled our criteria and were included. After detailed investigations, the final adjudicated diagnosis was acute coronary syndrome in 30 patients (including acute myocardial infarction in 13 and unstable angina in 17) and non-acute coronary syndrome in 28 patients. Measured on admission, hs-cTnT concentration was > 14 ng/mL (99 th percentile) in 22 patients with acute coronary syndrome; repetition of the measurement at 3 hours and 6 hours identified three and four additional patients, respectively. The combination of copeptin with hs-cTnT determined on admission identified 26 patients with acute coronary syndrome, with a negative predicted value of 82.6%. The area under the receiver operating characteristic curve was 0.90 for hs-cTnT measured on admission, and 0.94 if repeated at 3 hours and 6 hours or combined with copeptin measurement at admission (non-significant difference).
This prospective study demonstrated that a dual marker strategy that combines hs-cTnT with copeptin increased slightly the detection of acute coronary syndrome at admission.
高敏心肌肌钙蛋白检测提高了急性冠状动脉综合征的检出率。
探讨 copeptin 在急性冠状动脉综合征检测中的可能附加价值。
我们设计了一项前瞻性队列研究，比较入院时同时检测高敏心肌肌钙蛋白 T（hs-cTnT）和 copeptin 与单独检测入院时、3 小时和 6 小时 hs-cTnT 对症状发作后<6 小时的疑似急性冠状动脉综合征患者（排除 ST 段抬高型心肌梗死患者）的诊断性能。
58 例连续患者符合我们的标准并被纳入研究。经过详细检查，最终确定 30 例患者为急性冠状动脉综合征（包括急性心肌梗死 13 例，不稳定型心绞痛 17 例），28 例为非急性冠状动脉综合征。入院时测定 hs-cTnT 浓度>14ng/ml（99 百分位）的 22 例患者中，有 3 例和 4 例分别在 3 小时和 6 小时重复检测时被诊断为急性冠状动脉综合征。入院时联合检测 copeptin 和 hs-cTnT 可确定 26 例急性冠状动脉综合征患者，阴性预测值为 82.6%。入院时测定 hs-cTnT 的受试者工作特征曲线下面积为 0.90，在 3 小时和 6 小时重复测定或与入院时的 copeptin 测定相结合时为 0.94（无显著性差异）。
这项前瞻性研究表明，hs-cTnT 与 copeptin 的双标志物策略略微提高了入院时急性冠状动脉综合征的检出率。
