在患有既往冠状动脉疾病和疑似急性心肌梗死的患者中， copeptin 和高敏心肌肌钙蛋白 T 的诊断和预后影响。
Diagnostic and prognostic impact of copeptin and high-sensitivity cardiac troponin T in patients with pre-existing coronary artery disease and suspected acute myocardial infarction.
机构信息
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
出版信息
Heart. 2012 Apr;98(7):558-65. doi: 10.1136/heartjnl-2011-301269. Epub 2012 Feb 15.
OBJECTIVE
The early diagnosis of acute myocardial infarction (AMI) can be particularly challenging in patients with known coronary artery disease (CAD) due to pre-existing ECG changes and chronic increases in cardiac troponin (cTn) levels.
DESIGN
Of 1170 consecutive patients presenting with symptoms suggestive of AMI, 433 (37%) with pre-existing CAD were analysed in a prospective multicentre study and the diagnostic and prognostic impact of copeptin in combination with either fourth generation cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT) was evaluated.
RESULTS
AMI was the final diagnosis in 78 patients with pre-existing CAD (18%). Copeptin was significantly higher in patients with AMI than in those without (26 pmol/l (IQR 9-71) vs 7 pmol/l (IQR 4-16), p<0.001). The diagnostic accuracy for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was significantly higher for the combination of copeptin and cTnT than for cTnT alone (0.94 vs 0.86, p<0.001). The combination of copeptin and hs-cTnT (0.94) was trending to superiority compared with hs-cTnT alone (0.92, p=0.11). The combination of copeptin and the cTn assays was able to improve the negative predictive value up to 99.5% to rule out AMI. Copeptin was a strong and independent predictor of 1-year mortality (HR 4.18-4.63). Irrespective of cTn levels, patients with low levels of copeptin had an excellent prognosis compared with patients with raised levels of both copeptin and cTn (360-day mortality 2.8-3.6% vs 23.1-33.8%, p<0.001).
CONCLUSION
In patients with pre-existing CAD, copeptin significantly improves the diagnostic accuracy if used in addition to cTnT, but only trended to superiority compared with hs-cTnT alone. Copeptin provides independent prognostic information, largely by overcoming the challenging interpretation of mild increases in hs-cTnT.
CLINICAL TRIAL REGISTRATION NUMBER
ClinicalTrials Gov number NCT00470587.
目的
在已知患有冠状动脉疾病（CAD）的患者中，急性心肌梗死（AMI）的早期诊断可能特别具有挑战性，因为存在先前的心电图改变和慢性心肌肌钙蛋白（cTn）水平升高。
设计
在一项前瞻性多中心研究中，对 1170 例有 AMI 症状的连续患者进行了分析，其中 433 例（37%）患有先前存在的 CAD，并评估了 copeptin 与第四代心脏肌钙蛋白 T（cTnT）或高敏 cTnT（hs-cTnT）联合使用的诊断和预后影响。
结果
在先前存在 CAD 的 78 例患者中，AMI 是最终诊断（18%）。AMI 患者的 copeptin 显著高于无 AMI 患者（26 pmol/l [IQR 9-71] vs 7 pmol/l [IQR 4-16]，p<0.001）。通过接受者操作特征曲线（ROC）下面积（AUC）定量的 AMI 诊断准确性，copeptin 与 cTnT 联合检测显著高于 cTnT 单独检测（0.94 与 0.86，p<0.001）。与 hs-cTnT 单独检测（0.92，p=0.11）相比，copeptin 与 hs-cTnT 的联合检测具有优势。copeptin 与 cTn 检测联合使用能够将阴性预测值提高至 99.5%，以排除 AMI。Copeptin 是 1 年死亡率的强有力和独立预测因子（HR 4.18-4.63）。无论 cTn 水平如何，低水平 copeptin 的患者预后明显优于 copeptin 和 cTn 水平均升高的患者（360 天死亡率 2.8-3.6%与 23.1-33.8%，p<0.001）。
结论
在患有先前存在 CAD 的患者中，如果将 copeptin 与 cTnT 联合使用，其诊断准确性显著提高，但与 hs-cTnT 单独检测相比仅呈优势趋势。Copeptin 提供了独立的预后信息，主要通过克服 hs-cTnT 轻度升高的挑战性解释。
临床试验注册号
ClinicalTrials Gov 编号 NCT00470587。
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