This article is more than 5 years old. Information may no longer be current.

Rapid rule-out of acute MI aided by troponin T and copeptin levels

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Evaluating copeptin levels together with troponin T levels at presentation of acute MI symptoms can aid in the rapid diagnosis or rule-out of the condition, according to a study in this week’s Journal of the American College of Cardiology.

Researchers for the single-center study enrolled 487 consecutive patients presenting to the ED with symptoms suggesting acute MI. The researchers evaluated copeptin levels along with an initial clinical assessment that included clinical history, physical examination, 12-lead ECG and continuous ECG monitoring and assessment of troponin T levels.

According to the study results, copeptin levels were higher in patients with acute MI vs. patients with other diagnoses (P<.001 for all comparisons). Among the 81 patients who had acute MI, copeptin levels were higher than in patients with an initial troponin T level <0.01 mcg/L compared with patients with troponin T levels >0.01 mcg/L (P<.001). Although the diagnostic accuracy of troponin T levels at presentation in the diagnosis of acute MI was higher (AUC=0.86; 95% CI, 0.80-0.92) than the accuracy for copeptin levels alone (AUC=0.75; 95% CI, 0.69-0.81; P=.009 for difference), the combination of troponin T levels and copeptin increased the diagnostic accuracy of troponin T alone (AUC=0.97; 95% CI, 0.95-0.98; P<.001). The researchers also reported that a copeptin level of <14 pmol/L combined with a troponin T level of <0.01 mcg/L would have correctly ruled out acute MI at presentation with a sensitivity of 98.8%, a negative predictive value of 99.7%, a positive predictive value of 46.2% and a specificity of 77.1%.

“The combination of copeptin and troponin significantly improved the diagnostic accuracy for acute MI at presentation as compared to troponin alone,” the researchers concluded. “Consequently, the additional use of copeptin may allow for a rapid and accurate rule-out of acute MI and might obviate the need for prolonged monitoring and serial blood sampling in ED for the majority of patients. This fundamental change in clinical practice may provide the opportunity to significantly improve patient management in the ED and to reduce treatment cost.”

For more information:

• Reichlin T. J Am Coll Cardiol. 2009;54:60-68.