Restan, Ingar Ziad 
ORCID: 0000-0001-8922-7014, Sanchez, Ana Yufera, Steiro, Ole-Thomas ORCID: 0000-0003-2520-9436, Lopez-Ayala, Pedro ORCID: 0000-0002-7787-0640, Tjora, Hilde L ORCID: 0000-0003-2577-5497, Langørgen, Jørund ORCID: 0000-0003-3037-054X, Omland, Torbjørn ORCID: 0000-0002-6452-0369, Boeddinghaus, Jasper, Nestelberger, Thomas ORCID: 0000-0003-2173-5738, Koechlin, Luca ORCID: 0000-0002-2929-8600 et al (show 10 more authors)
(2022)
Adding stress biomarkers to high-sensitivity cardiac troponin for rapid non-ST-elevation myocardial infarction rule-out protocols.
European heart journal. Acute cardiovascular care, 11 (3).
pp. 201-212.
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Abstract
<h4>Aims</h4>This study tested the hypothesis that combining stress-induced biomarkers (copeptin or glucose) with high-sensitivity cardiac troponin (hs-cTn) increases diagnostic accuracy for non-ST-elevation myocardial infarction (NSTEMI) in patients presenting to the emergency department.<h4>Methods and results</h4>The ability to rule-out NSTEMI for combinations of baseline hs-cTnT or hs-cTnI with copeptin or glucose was compared with the European Society of Cardiology (ESC) hs-cTnT/I-only rule-out algorithms in two independent (one Norwegian and one international multicentre) diagnostic studies. Among 959 patients (median age 64 years, 60.5% male) with suspected NSTEMI in the Norwegian cohort, 13% had NSTEMI. Adding copeptin or glucose to hs-cTnT/I as a continuous variable did not improve discrimination as quantified by the area under the curve {e.g. hs-cTnT/copeptin 0.91 [95% confidence interval (CI) 0.89-0.93] vs. hs-cTnT alone 0.91 (95% CI 0.89-0.93); hs-cTnI/copeptin 0.85 (95% CI 0.82-0.87) vs. hs-cTnI alone 0.93 (95% CI 0.91-0.95)}, nor did adding copeptin <9 mmol/L or glucose <5.6 mmol/L increase the sensitivity of the rule-out provided by hs-cTnT <5 ng/L or hs-cTnI <4 ng/L in patients presenting more than 3 h after chest pain onset (target population in the ESC-0 h-algorithm). The combination decreased rule-out efficacy significantly (both P < 0.01). These findings were confirmed among 1272 patients (median age 62 years, 69.3% male) with suspected NSTEMI in the international validation cohort, of which 20.7% had NSTEMI. A trend towards increased sensitivity for the hs-cTnT/I/copeptin combinations (97-100% vs. 91-97% for the ESC-0 h-rule-out cut-offs) was observed in the Norwegian cohort.<h4>Conclusion</h4>Adding copeptin or glucose to hs-cTnT/I did not increase diagnostic performance when compared with current ESC guideline hs-cTnT/I-only 0 h-algorithms.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Myocardial Infarction, Troponin I, Troponin T, Prospective Studies, Middle Aged, Female, Male, Biomarkers, Non-ST Elevated Myocardial Infarction |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Nov 2022 16:54 |
| Last Modified: | 18 Jan 2023 19:43 |
| DOI: | 10.1093/ehjacc/zuab124 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166078 |
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