Combined testing of copeptin and high-sensitivity cardiac troponin T at presentation in comparison to other algorithms for rapid rule-out of acute myocardial infarction
Por:
Mueller-Hennessen, M, Lindahl, B, Giannitsis, E, Vafaie, M, Biener, M, Haushofer, AC, Seier, J, Christ, M, Alquezar-Arbe, A, DeFilippi, CR, McCord, J, Body, R, Panteghini, M, Jernberg, T, Plebani, M, Verschuren, F, French, JK, Christenson, RH, Dinkel, C, Katus, HA, Mueller, C, TRAPID-AMI Investigators
Publicada:
1 feb 2019
Resumen:
Background: We aimed to directly compare the diagnostic and prognostic performance of a dual maker strategy (DMS) with combined testing of copeptin and high-sensitivity (hs) cardiac troponin T (cTnT) at time of presentation with other algorithms for rapid rule-out of acute myocardial infarction (AM1).
Methods: 922 patients presenting to the emergency department with suspected AMI and available baseline copeptin measurements qualified for the present TRAPID-AMI substudy. Diagnostic measures using the DMS (copeptin <10, <14 or < 20 pmol/L and hs-cTriT14 ng/L), the 1 h-algorithm (hs-cTnT 12 ng/L and change <3 ng/t at 1 h), as well as the hs-cTnT limit-of-blank (LoB, <3 ng/t) and-detection (LoD, <5 ng/L) were compared. Outcomes were assessed as combined end-points of death and myocardial re-infarction.
Results: True negative rule-out using the DMS could be achieved in 50.9%-62.3% of all patients compared to 35.0%, 453% and 64.5% using LoB, LoD or the 1 h-algorithm, respectively.The DMS showed NPVs of 98.1%-983% compared to 992% for the 1 h-algorithm, 99.4% for the LoB and 993% for the LoD. Sensitivities were 93.5%-94.8%, as well as 96.8%, 98.7% and 98.1%, respectively. Addition of clinical low-risk criteria such as a HEART score <3 to the DMS resulted in NPVs and sensitivities of 100 with a true-negative rule-out to 33.8%-41.6%. Rates of the combined endpoint of death/MI within 30 days ranged between 02% and 0.3% for all fast-rule-out protocols.
Conclusion: Depending on the applied copeptin cu off and addition of clinical low-risk criteria, the DMS might be an alternative to the hs-an-only-based algorithms for rapid AMI rule-out with comparable diagnostic measures and outcomes. (C) 2018 Elsevier B.V. All rights reserved.
Filiaciones:
Mueller-Hennessen, M:
Heidelberg Univ Hosp, Dept Internal Med III Cardiol Angiol & Pulmonol, Heidelberg, Germany
Lindahl, B:
Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden
Giannitsis, E:
Heidelberg Univ Hosp, Dept Internal Med III Cardiol Angiol & Pulmonol, Heidelberg, Germany
Vafaie, M:
Heidelberg Univ Hosp, Dept Internal Med III Cardiol Angiol & Pulmonol, Heidelberg, Germany
Biener, M:
Heidelberg Univ Hosp, Dept Internal Med III Cardiol Angiol & Pulmonol, Heidelberg, Germany
Haushofer, AC:
Klinikum Wels Grieskirchen, Cent Lab, Wels, Austria
Seier, J:
Klinikum Wels Grieskirchen, Cent Lab, Wels, Austria
Christ, M:
Community Hosp, Dept Emergency & Crit Care Med, Nurnberg, Germany
Paracelsus Med Univ, Nurnberg, Germany
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
DeFilippi, CR:
Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA
McCord, J:
Henry Ford Hlth Syst, Henry Ford Heart & Vasc Inst, Detroit, MI USA
Body, R:
Univ Manchester, Div Cardiovasc Sci, Manchester, Lancs, England
Manchester Univ NHS Fdn Trust, Manchester, Lancs, England
Panteghini, M:
Univ Milan, Med Sch, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy
Jernberg, T:
Danderyd Univ, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden
Plebani, M:
Univ Hosp Padova, Dept Lab Med, Padua, Italy
Verschuren, F:
Clin Univ St Luc, Dept Acute Med, Brussels, Belgium
Catholic Univ Louvain, Brussels, Belgium
French, JK:
Liverpool Hosp, Sydney, NSW, Australia
Univ New South Wales, Sydney, NSW, Australia
Christenson, RH:
Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA
Dinkel, C:
Roche Diagnost Germany, Penzberg, Germany
Katus, HA:
Heidelberg Univ Hosp, Dept Internal Med III Cardiol Angiol & Pulmonol, Heidelberg, Germany
Mueller, C:
Univ Hosp Basel, Cardiol & Cardiovasc Res Inst Basel, Basel, Switzerland
Green Submitted
|