Wildi Karin, Zellweger Christa, Twerenbold Raphael, Jaeger Cedric, Reichlin Tobias, Haaf Philip, Faoro Jonathan, Giménez Maria Rubini, Fischer Andreas, Nelles Berit, Druey Sophie, Krivoshei Lian, Hillinger Petra, Puelacher Christian, Herrmann Thomas, Campodarve Isabel, Rentsch Katharina, Steuer Stephan, Osswald Stefan, Mueller Christian
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland; Pneumology Department, Parc de Salut Mar-IMIM-UPF CIBERES (ISC iii), Barcelona, Spain; Emergency Department, Parc de Salut Mar, Barcelona, Spain.
Int J Cardiol. 2015;190:170-6. doi: 10.1016/j.ijcard.2015.04.133. Epub 2015 Apr 17.
The incremental value of copeptin, a novel marker of endogenous stress, for rapid rule-out of non-ST-elevation myocardial infarction (NSTEMI) is unclear when sensitive or even high-sensitivity cardiac troponin cTn (hs-cTn) assays are used.
In an international multicenter study we evaluated 1929 consecutive patients with symptoms suggestive of acute myocardial infarction (AMI). Measurements of copeptin, three sensitive and three hs-cTn assays were performed at presentation in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists using all clinical information including coronary angiography and levels of hs-cTnT. The incremental value in the diagnosis of NSTEMI was quantified using four outcome measures: area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), sensitivity and negative predictive value (NPV). Early presenters (< 4h since chest pain onset) were a pre-defined subgroup.
NSTEMI was the adjudicated final diagnosis in 358 (18.6%) patients. As compared to the use of cTn alone, copeptin significantly increased AUC for two (33%) and IDI (between 0.010 and 0.041 (all p < 0.01)), sensitivity and NPV for all six cTn assays (100%); NPV to 96-99% when the 99 th percentile of the respective cTnI assay was combined with a copeptin level of 9 pmol/l (all p < 0.01). The incremental value in early presenters was similar to that of the overall cohort.
When used for rapid rule-out of NSTEM in combination with sensitive or hs-cTnI assays, copeptin provides a numerically small, but statistically and likely also clinically significant incremental value.
当使用敏感甚至高敏心肌肌钙蛋白（hs-cTn）检测时，内源性应激的新型标志物copeptin在快速排除非ST段抬高型心肌梗死（NSTEMI）方面的增量价值尚不清楚。
在一项国际多中心研究中，我们评估了1929例连续出现急性心肌梗死（AMI）症状的患者。在就诊时以盲法进行copeptin、三种敏感和三种hs-cTn检测。最终诊断由两名独立的心脏病专家根据所有临床信息（包括冠状动脉造影和hs-cTnT水平）进行判定。使用四种结果指标对NSTEMI诊断中的增量价值进行量化：受试者操作特征曲线下面积（AUC）、综合鉴别改善（IDI）、敏感性和阴性预测值（NPV）。早期就诊者（胸痛发作后<4小时）是一个预先定义的亚组。
358例（18.6%）患者的最终诊断为NSTEMI。与单独使用cTn相比，copeptin显著提高了两种（33%）检测的AUC和IDI（0.010至0.041之间（所有p<0.01）），以及所有六种cTn检测的敏感性和NPV（100%）；当将各自cTnI检测值的第99百分位数与copeptin水平9 pmol/l相结合时，NPV提高到96-99%（所有p<0.01）。早期就诊者的增量价值与总体队列相似。
当与敏感或hs-cTnI检测联合用于快速排除NSTEM时，copeptin提供的数值增量虽小，但在统计学上以及可能在临床上也具有显著意义。
