Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea.
PLoS One. 2018 Jul 6;13(7):e0200379. doi: 10.1371/journal.pone.0200379. eCollection 2018.
This study aimed to determine the diagnostic accuracy of adding copeptin to cardiac troponin (cTn) on admission to the emergency department (ED) for non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone.
A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed (search date: April 13, 2018). Primary studies were included if they accurately reported on patients with symptoms suggestive of acute myocardial infarction and measured both cTn alone and cTn with copeptin upon admission to the ED. The patients with evidence of ST elevation myocardial infarction were excluded. To assess the risk of bias for the included studies, the QUADAS-2 tool was used.
The study participants included a total of 7,998 patients from 14 observational studies. The addition of copeptin to cTn significantly improved the sensitivity (0.81 [0.74 to 0.87] vs. 0.92 [0.89 to 0.95], respectively, p <0.001) and negative predictive value (0.96 [0.95 to 0.98] vs. 0.98 [0.96 to 0.99], respectively, p <0.001) at the expense of lower specificity (0.88 [0.80 to 0.97] vs. 0.57 [0.49 to 0.65], respectively, p <0.001) compared to cTn alone. Furthermore, adding copeptin to cTn showed significantly lower diagnostic accuracy for NSTEMI compared to cTn alone (0.91[0.90 to 0.92] vs. 0.85 [0.83 to 0.86], respectively, p < 0.001).
Adding copeptin to cTn improved the sensitivity and negative predictive value for the diagnosis of NSTEMI compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the ED.
本研究旨在确定与单独使用肌钙蛋白（cTn）相比，入院时在急诊科（ED）检测加压素原（copeptin）对非 ST 段抬高型心肌梗死（NSTEMI）的诊断准确性。
对 MEDLINE、EMBASE 和 Cochrane 图书馆进行了文献检索（检索日期：2018 年 4 月 13 日）。如果研究准确报告了有急性心肌梗死症状且入院时同时检测了 cTn 与 copeptin 的患者，就将其纳入研究。排除有 ST 段抬高型心肌梗死证据的患者。为了评估纳入研究的偏倚风险，使用了 QUADAS-2 工具。
研究参与者包括来自 14 项观察性研究的共 7998 名患者。与单独使用 cTn 相比，cTn 联合 copeptin 显著提高了诊断的敏感性（0.81[0.74 至 0.87] 与 0.92[0.89 至 0.95]，p<0.001）和阴性预测值（0.96[0.95 至 0.98] 与 0.98[0.96 至 0.99]，p<0.001），而特异性降低（0.88[0.80 至 0.97] 与 0.57[0.49 至 0.65]，p<0.001）。此外，与单独使用 cTn 相比，cTn 联合 copeptin 对 NSTEMI 的诊断准确性显著降低（0.91[0.90 至 0.92] 与 0.85[0.83 至 0.86]，p<0.001）。
与单独使用 cTn 相比，入院时在 cTn 基础上增加 copeptin 可提高 NSTEMI 的诊断敏感性和阴性预测值。因此，入院时在 cTn 基础上增加 copeptin 可能有助于早期筛查 ED 中的 NSTEMI。
