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

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

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVES: We tested the noninferiority of a fast-track rule-out protocol for the diagnosis of non-ST-segment elevation myocardial infarction vs noncoronary chest pain based on the single-sampling combined assessment of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin compared with the serial assessment of medium-sensitivity cardiac troponin I.

METHODS: Ultra-sensitive copeptin and medium-sensitivity cardiac troponin I levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute nontraumatic chest pain within 6 hours from symptoms onset and without ST-segment elevation on a 12-lead electrocardiogram. The diagnostic performance for non-ST-segment elevation myocardial infarction diagnosis of the dual-marker single-sampling strategy with medium-sensitivity cardiac troponin I and ultra-sensitive copeptin on admission was compared with that of the serial 0- and 3-hour medium-sensitivity cardiac troponin I sampling in reference to the adjudicated postdischarge diagnosis, using both the comparison of area under the curve (AUC) receiver operating characteristic and the McNemar chi-square test.

RESULTS: The diagnosis of non-ST-segment elevation myocardial infarction was adjudicated in 29 patients (14.8%). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin generated an AUC of 0.87 (95% confidence interval, 0.82-0.91), which was noninferior with respect to the 3-hour interval medium-sensitivity cardiac troponin I serial sampling (P = .194 for AUC difference). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; P = not significant).

CONCLUSIONS: A single-sampling strategy of combined ultra-sensitive copeptin and medium-sensitivity cardiac troponin I is noninferior to a 0- and 3-hour serial medium-sensitivity cardiac troponin I sampling in ruling out non-ST-segment elevation myocardial infarction and thus may allow an earlier discharge of patients who are ruled out for non-ST-segment elevation myocardial infarction (ClinicalTrials.gov Identifier NCT01962506).

Original languageEnglish (US)
Pages (from-to)105-114
Number of pages10
JournalAmerican Journal of Medicine
Volume129
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Troponin
Troponin I
Acute Coronary Syndrome
Area Under Curve
Chest Pain
copeptins
Dual (Psychiatry) Diagnosis
Chi-Square Distribution
ROC Curve
Hospital Emergency Service
Electrocardiography
Non-ST Elevated Myocardial Infarction
Confidence Intervals

Keywords

  • Biomarkers
  • Cardiac troponin
  • Copeptin
  • Early discharge
  • Emergency department
  • Myocardial infarction
  • Non–ST-segment elevation myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes--The COPACS Study. / Ricci, Fabrizio; Di Scala, Rosa; Massacesi, Cristiano; Di Nicola, Marta; Cremonese, Gianni; De Pace, Doranna; Rossi, Serena; Griffo, Irma; Cataldo, Ivana; Martinotti, Stefano; Rotondo, Domenico; Jaffe, Allan S; Zimarino, Marco; De Caterina, Raffaele.

In: American Journal of Medicine, Vol. 129, No. 1, 01.01.2016, p. 105-114.

Research output: Contribution to journalArticle

Ricci, F, Di Scala, R, Massacesi, C, Di Nicola, M, Cremonese, G, De Pace, D, Rossi, S, Griffo, I, Cataldo, I, Martinotti, S, Rotondo, D, Jaffe, AS, Zimarino, M & De Caterina, R 2016, 'Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes--The COPACS Study', American Journal of Medicine, vol. 129, no. 1, pp. 105-114. https://doi.org/10.1016/j.amjmed.2015.06.033
Ricci, Fabrizio ; Di Scala, Rosa ; Massacesi, Cristiano ; Di Nicola, Marta ; Cremonese, Gianni ; De Pace, Doranna ; Rossi, Serena ; Griffo, Irma ; Cataldo, Ivana ; Martinotti, Stefano ; Rotondo, Domenico ; Jaffe, Allan S ; Zimarino, Marco ; De Caterina, Raffaele. / Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes--The COPACS Study. In: American Journal of Medicine. 2016 ; Vol. 129, No. 1. pp. 105-114.
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AU - Di Scala, Rosa

AU - Massacesi, Cristiano

AU - Di Nicola, Marta

AU - Cremonese, Gianni

AU - De Pace, Doranna

AU - Rossi, Serena

AU - Griffo, Irma

AU - Cataldo, Ivana

AU - Martinotti, Stefano

AU - Rotondo, Domenico

AU - Jaffe, Allan S

AU - Zimarino, Marco

AU - De Caterina, Raffaele

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N2 - OBJECTIVES: We tested the noninferiority of a fast-track rule-out protocol for the diagnosis of non-ST-segment elevation myocardial infarction vs noncoronary chest pain based on the single-sampling combined assessment of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin compared with the serial assessment of medium-sensitivity cardiac troponin I.METHODS: Ultra-sensitive copeptin and medium-sensitivity cardiac troponin I levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute nontraumatic chest pain within 6 hours from symptoms onset and without ST-segment elevation on a 12-lead electrocardiogram. The diagnostic performance for non-ST-segment elevation myocardial infarction diagnosis of the dual-marker single-sampling strategy with medium-sensitivity cardiac troponin I and ultra-sensitive copeptin on admission was compared with that of the serial 0- and 3-hour medium-sensitivity cardiac troponin I sampling in reference to the adjudicated postdischarge diagnosis, using both the comparison of area under the curve (AUC) receiver operating characteristic and the McNemar chi-square test.RESULTS: The diagnosis of non-ST-segment elevation myocardial infarction was adjudicated in 29 patients (14.8%). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin generated an AUC of 0.87 (95% confidence interval, 0.82-0.91), which was noninferior with respect to the 3-hour interval medium-sensitivity cardiac troponin I serial sampling (P = .194 for AUC difference). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; P = not significant).CONCLUSIONS: A single-sampling strategy of combined ultra-sensitive copeptin and medium-sensitivity cardiac troponin I is noninferior to a 0- and 3-hour serial medium-sensitivity cardiac troponin I sampling in ruling out non-ST-segment elevation myocardial infarction and thus may allow an earlier discharge of patients who are ruled out for non-ST-segment elevation myocardial infarction (ClinicalTrials.gov Identifier NCT01962506).

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