Department of Cardiology and Cardiovascular Research Institute Basel and.
Department of Cardiology and Cardiovascular Research Institute Basel and Servicio de Urgencias, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain;
Clin Chem. 2015 Dec;61(12):1466-74. doi: 10.1373/clinchem.2015.242743. Epub 2015 Aug 31.
Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high-although still imperfect-negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV.
In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive).
The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%-99.7%, P < 0.001).
One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings. ClinicalTrials.gov/NCT00470587.
在呈现时联合检测高敏心肌肌钙蛋白 T（hs-cTnT）和 copeptin 可非常高——尽管仍然不完美——预测急性心肌梗死（AMI）的早期排除。我们假设在 1 小时时进行第二次 copeptin 测量可能会进一步增加阴性预测值（NPV）。
在一项前瞻性诊断多中心研究中，我们在 1439 名因疑似 AMI 就诊急诊科的未选择患者中，在呈现时和 1 小时时测量 hs-cTnT 和 copeptin 浓度。最终诊断由 2 位独立的、对 copeptin 浓度盲法的心脏病专家裁决。我们研究了 1 小时 copeptin 在排除设定（0 小时 hs-cTnT 阴性和 0 小时 copeptin 阴性）和中间风险设定（0 小时 hs-cTnT 阴性和 0 小时 copeptin 阳性）中的增量价值。
裁决诊断为 AMI 的患者有 267 例（18.6%）。在排除设定中，呈现时测量的 NPV 为 98.6%（95%CI，97.4%-99.3%）。虽然 1 小时 copeptin 并未显著增加 NPV，但 1 小时 hs-cTnT 增加至 99.6%（95%CI，98.7%-99.9%，P=0.008）。同样，在中间风险设定中（NPV 为 92.8%，95%CI，88.7%-95.8%），1 小时 copeptin 并未显著增加 NPV（P=0.751），但 1 小时 hs-cTnT 增加至 98.6%（95%CI，96%-99.7%，P<0.001）。
1 小时 copeptin 既没有增加排除过程的安全性，也没有增加中间风险设定的 NPV。相比之下，1 小时 hs-cTnT 的增量价值在两个设定中都很大。ClinicalTrials.gov/NCT00470587。
