Stengaard Carsten, Sørensen Jacob T, Ladefoged Søren A, Lassen Jens F, Rasmussen Martin B, Pedersen Claus Kjær, Ayer Antoine, Bøtker Hans Erik, Terkelsen Christian J, Thygesen Kristian
a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
b Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark.
Biomarkers. 2017 May-Jun;22(3-4):351-360. doi: 10.1080/1354750X.2016.1265008. Epub 2016 Dec 12.
In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase.
In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model. Multivariable Cox regression modelling was used to estimate the predictive value of both biomarkers.
In total, 178 (19%) cases had AMI. The AUC for hs-cTnT was 0.81. Adding copeptin increased the AUC to 0.85 (p = 0.004) and the combined model allowed a prehospital rule-out of 45% of cases without AMI (negative predictive value, NPV 98%). Both biomarkers are highly predictive of outcome.
A future application of hs-cTnT and copeptin measurement, performed already in the prehospital phase, could potentially improve the prehospital diagnostic and prognostic classification of patients with a suspected AMI.
在疑似急性心肌梗死（AMI）患者中，基于对院前采集血样中高敏心肌肌钙蛋白T（hs-cTnT）和 copeptin 的检测，评估早期分诊的可能性。
在这项回顾性研究中，我们检测了 962 例疑似 AMI 患者在救护车上采集血样中的 hs-cTnT 和 copeptin。通过两种生物标志物及联合模型的受试者工作特征（ROC）曲线下面积（AUC）评估诊断准确性。采用多变量 Cox 回归模型评估两种生物标志物的预测价值。
总共 178 例（19%）患者患有 AMI。hs-cTnT 的 AUC 为 0.81。加入 copeptin 后，AUC 增至 0.85（p = 0.004），联合模型可在院前排除 45%无 AMI 的病例（阴性预测值，NPV 98%）。两种生物标志物对预后均具有高度预测性。
在院前阶段就进行 hs-cTnT 和 copeptin 检测的未来应用可能会改善疑似 AMI 患者的院前诊断和预后分类。
