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.
Int J Cardiol
; 276: 261-267, 2019 Feb 01.
Article
en En
| MEDLINE
| ID: mdl-30404726
ABSTRACT
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 (AMI).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 orâ¯<â¯20â¯pmol/L and hs-cTnT≤14â¯ng/L), the 1â¯h-algorithm (hs-cTnT<12â¯ng/L and change <3â¯ng/L at 1â¯h), as well as the hs-cTnT limit-of-blank (LoB, <3â¯ng/L) and -detection (LoD, <5â¯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%, 45.3% and 64.5% using LoB, LoD or the 1â¯h-algorithm, respectively. The DMS showed NPVs of 98.1%-98.3% compared to 99.2% for the 1â¯h-algorithm, 99.4% for the LoB and 99.3% 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-scoreâ¯≤â¯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 end-point of death/MI within 30â¯days ranged between 0.2% and 0.3% for all fast-rule-out protocols.CONCLUSION:
Depending on the applied copeptin cut-off and addition of clinical low-risk criteria, the DMS might be an alternative to the hs-cTn-only-based algorithms for rapid AMI rule-out with comparable diagnostic measures and outcomes.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cardiovascular_diseases
/
6_ischemic_heart_disease
Asunto principal:
Algoritmos
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Glicopéptidos
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Troponina T
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Electrocardiografía
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Infarto del Miocardio
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Cardiol
Año:
2019
Tipo del documento:
Article
País de afiliación:
Alemania