Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis

Abstract

IntroductionThis 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.Materials and methodsA 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.ResultsThe 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).ConclusionsAdding 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.

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

“…Addition of copeptin to TnI improved sensitivity and NPV compared with TnI alone (Table 2). These findings are consistent with the previous findings [2021]. ROC curve comparison results showed that a combination of TnI and copeptin also improved diagnostic performance, specifically at ≤two hours after chest pain onset; thus, this combination might accelerate therapeutic decision-making in patients with suspected AMI.…”

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

“…43 A recent metaanalysis by Shin et al showed that adding copeptin to hs-cTnT improved the sensitivity for rule-out of AMI. 44 Our meta-analysis exclusively investigated the ability of the hs-cTnT assay to rule out AMI with the two most frequently reported serial measurement strategies. We found similar diagnostic accuracy for rule-out of AMI with serial high-sensitivity troponin measurements <99 th percentile compared to the study by Lipinski et al 37 Recently, Badertscher et al directly compared the onehour algorithm with the three-hour algorithm, which uses a fixed cut-off (the 99 th percentile) at presentation and three hours in conjunction with clinical criteria (Global Registry of Acute Events (GRACE) score <140 and the requirement to be pain free).…”

Evaluation of Copeptin for Diagnosing Non-ST Segment Elevation Acute Myocardial Infarction in Patients with Chest pain and Mild Troponin I Elevation

“…infarction in patients with chest pain [14][15][16]. A meta-analysis revealed that the copeptin plus cTn combination had signi cantly greater sensitivity and NPV for NSTEMI than cTn alone [17]. In our patients with mild troponin elevation, the NPV of copeptin was excellent, and copeptin plus TnI exhibited higher diagnostic accuracy than CK-MB plus TnI for NSTEMI, as revealed by the AUC values (0.898 vs. 0.711).…”