Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes—The COPACS Study

Ricci, Fabrizio; Scala, Rosa Di; Massacesi, Cristiano; Nicola, Marta Di; Cremonese, Gianni; Pace, Doranna De; Rossi, Serena; Griffo, Irma; Cataldo, Ivana; Martinotti, Stefano; Rotondo, Domenico; Jaffe, Allan S.; Zimarino, Marco; Caterina, Raffaele De

doi:10.1016/j.amjmed.2015.06.033

Cited by 9 publications

(5 citation statements)

References 37 publications

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“…Our findings corroborate previous data on the diagnostic and prognostic yield of competing rule-out strategies for MI (10,(32)(33)(34)(35)(36), providing evidence on their comparable clinical performance regardless of time of symptom onset, GRACE risk score and renal function status.…”

Section: Discussionsupporting

confidence: 90%

High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction

Ricci

Neumann

Rübsamen³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe instant, single-sampling rule-out of acute myocardial infarction (AMI) is still an unmet clinical need. We aimed at testing and comparing diagnostic performance and prognostic value of two different single-sampling biomarker strategies for the instant rule-out of AMI.MethodsFrom the Biomarkers in Acute Cardiac Care (BACC) cohort, we recruited consecutive patients with acute chest pain and suspected AMI presenting to the Emergency Department of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany. We compared safety, effectiveness and 12-month incidence of the composite endpoint of all-cause death and myocardial infarction between (i) a single-sampling, dual-marker pathway combining high-sensitivity cardiac troponin I (hs-cTnI) and ultra-sensitive copeptin (us-Cop) at presentation (hs-cTnI ≤ 27 ng/L, us-Cop < 10 pmol/L and low-risk ECG) and (ii) a single-sampling pathway based on one-off hs-cTnI determination at presentation (hs-cTnI < 5 ng/L and low-risk ECG). As a comparator, we used the European Society of Cardiology (ESC) 0/1-h dual-sampling algorithm.ResultsWe enrolled 1,136 patients (male gender 65%) with median age of 64 years (interquartile range, 51–75). Overall, 228 (20%) patients received a final diagnosis of AMI. The two single-sampling instant rule-out pathways yielded similar negative predictive value (NPV): 97.4% (95%CI: 95.4–98.7) and 98.7% (95%CI: 96.9–99.6) for dual-marker and single hs-cTnI algorithms, respectively (P = 0.11). Both strategies were comparably safe as the ESC 0/1-h dual-sampling algorithm and this was consistent across subgroups of early-comers, low-intermediate risk (GRACE-score < 140) and renal dysfunction. Despite a numerically higher rate of false-negative results, the dual-marker strategy ruled-out a slightly but significantly higher percentage of patients compared with single hs-cTnI determination (37.4% versus 32.9%; P < 0.001). There were no significant between-group differences in 12-month composite outcome.ConclusionsInstant rule-out pathways based on one-off determination of hs-cTnI alone or in combination with us-Cop are comparably safe as the ESC 0/1 h algorithm for the instant rule-out of AMI, yielding similar prognostic information. Instant rule-out strategies are safe alternatives to the ESC 0/1 h algorithm and allow the rapid and effective triage of suspected AMI in patients with low-risk ECG. However, adding copeptin to hs-cTn does not improve the safety of instant rule-out compared with the single rule-out hs-cTn at very low cut-off concentrations.

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Section: Discussionsupporting

confidence: 90%

High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction

Ricci

Neumann

Rübsamen³

et al. 2022

Front. Cardiovasc. Med.

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“…A study reported that the combined use of copeptin and cardiac troponin I is not inferior to serial cardiac troponin I measurement in ruling out NSTEMI. 22 However, this study used mediumsensitivity troponin assays. Another study investigated the single combined testing of troponin and copeptin to rule out AMI, and the proportion of major adverse cardiac events is not inferior in the copeptin group to that in the standard group.…”

Section: Discussionmentioning

confidence: 99%

Copeptin with high-sensitivity troponin at presentation is not inferior to serial troponin measurements for ruling out acute myocardial infarction

et al. 2020

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Objective We aimed to compare the multi-marker strategy (copeptin and high-sensitivity cardiac troponin I [hs-cTnI]) with serial hs-cTnI measurements to rule out acute myocardial infarction (AMI) in patients with chest pain. Methods This prospective observational study was performed in a single emergency department. To test the non-inferiority margin of 4% in terms of negative predictive value (NPV) between the multi-marker strategy (0 hour) and serial hs-cTnI measurements (0 and 2 hours), 262 participants were required. Samples for copeptin and hs-cTnI assays were collected at presentation (0 hour) and after 2 hours. The measured biomarkers were considered abnormal when hs-cTnI was >26.2 ng/L and when copeptin was >10 pmol/L. Results AMI was diagnosed in 28 patients (10.7%). The NPV of the multi-marker strategy was 100% (160/160; 95% confidence interval [CI], 97.7% to 100%), which was not inferior to that of serial hs-cTnI measurements (201/201; 100%; 95% CI, 98.2% to 100%). The sensitivity, specificity, and positive predictive value of the multi-marker strategy were 100% (95% CI, 87.7% to 100%), 68.1% (95% CI, 61.7% to 74.0%), and 27.2% (95% CI, 18.9% to 36.8%), respectively. The sensitivity, specificity, and positive predictive value of serial hs-cTnI measurements were 100% (95% CI, 87.7% to 100%), 85.5% (95% CI, 80.4% to 89.8%), and 45.2% (95% CI, 32.5% to 58.3%), respectively. Conclusion The multi-marker strategy (copeptin and hs-cTnI measurement) was not inferior to serial hs-cTnI measurements in terms of NPV for AMI diagnosis, with a sensitivity and NPV of 100%. Copeptin may help in the early rule-out of AMI in patients with chest pain.

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“…Characteristics of included studies. The 14 studies included a total of 7,998 patients, and the prevalence of NSTEMI was 14.2% (range 6.0-35.6%) [10,[15][16][17][18][19][20][21][22][23][24][25][26][27]. Only the CHOPIN study was a multinational study conducted in the USA and Europe, whereas all the other studies were conducted in Europe.…”

Section: Characteristics Of Study Subjectsmentioning

confidence: 99%

70 Diagnostic Accuracy of Adding Copeptin to Cardiac Troponin for Non-ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Kim¹,

Lim²,

Kim³

et al. 2018

Annals of Emergency Medicine

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Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes—The COPACS Study

Cited by 9 publications

References 37 publications

High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction

High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction

Copeptin with high-sensitivity troponin at presentation is not inferior to serial troponin measurements for ruling out acute myocardial infarction

70 Diagnostic Accuracy of Adding Copeptin to Cardiac Troponin for Non-ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

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