Copeptin Does Not Add Diagnostic Information to High-Sensitivity Troponin T in Low- to Intermediate-Risk Patients With Acute Chest Pain: Results From the Rule Out Myocardial Infarction by Computed Tomography (ROMICAT) Study

Study Questions:

Does the addition of copeptin, a peptide derived from the AVP precursor, have incremental value to a high-sensitivity cardiac troponin T (hs-cTnT) in patients presenting to the emergency department (ED) with acute chest pain and low to intermediate risk for acute coronary syndrome (ACS)?

Methods:

Patients who presented with acute chest pain to the ED and had a negative initial conventional troponin T test (<0.03 µg/L) were included. hs-cTnT and copeptin were measured, and cardiac computed tomography and coronary angiography was performed.

Results:

Baseline copeptin concentrations were not significantly different in patients with and without ACS (p = 0.24). Hs-cTnT showed an earlier rise in patients with ACS than copeptin, when analyses were stratified by time. A copeptin concentration ≥7.38 pmol/L had a negative predictive value (NPV) of 94% and a sensitivity of 51%. In contrast, hs-cTnT (≥13.0 pg/ml) was superior for both values, with a NPV of 96% and a sensitivity of 63%. Combining copeptin and hs-cTnT actually decreased diagnostic accuracy compared to hs-cTnT alone. Finally, copeptin concentrations were not associated with coronary artery morphology, although they were related to the presence of left ventricular dysfunction (p = 0.02).

Conclusions:

Among patients with acute chest pain and low to intermediate risk for ACS, copeptin concentrations are not independently predictive of ACS and do not add diagnostic value beyond that of hs-cTnT measurements.

Perspective:

This is a potentially important paper for those interested in the use of copeptin to help exclude acute myocardial infarction at an earlier point in time. This analysis suggests that with a higher sensitivity assay, the incremental value of copeptin in this situation that has been claimed with less sensitive assays, is ablated with higher sensitivity troponin assays.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Heart Failure and Cardiac Biomarkers, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Heart Diseases, Myocardial Infarction, Acute Coronary Syndrome, Biological Markers, Coronary Angiography, Tomography, Troponin T, Ventricular Dysfunction, Left


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