Copeptin Plus High-Sensitivity Cardiac Troponin T Effective for Instant NSTEMI Rule-Out

Copeptin combined with high-sensitivity cardiac troponin T (hs-cTnT) was found to be effective for instant rule-out of non-ST-segment myocardial infarction (NSTEMI), according to the results of a study published in Clinical Research in Cardiology.

The data from 5 trials (Biomarkers in Cardiology-8, Copeptin Helps in the early detection Of Patients with acute myocardial Infarction, the Pro-Core registry, Diagnostic evaluations, and the Study from Wilhelminen Hospital) collected between 2009 and 2017 were combined to evaluate the benefit of using copeptin combined with hs-cTnT (dual-marker strategy) vs hs-cTnT alone (single marker strategy) for ruling out STEMI. Two datasets were unpublished (Diagnostic evaluations and the Study from Wilhelminen Hospital).

In this cohort (n=10,329; mean age, 60.6 ±17.5 years), the mean estimated glomerular was 90.1±21.9), 20.6% of participants had diabetes mellitus, 33.8% had a history of coronary artery disease, 64.3% had hypertension, and 43.7% had hypercholesterolemia. Participants had low evaluation rate with hs-cTnT (44.5%), occurrence of NSTEMI (9.4%), and 30-day all-cause death rate (0.3%). The evaluation of 30-day all-cause mortality was missing for many of the patients (39.6%).

Negative predictive values (NPV) and sensitivities were higher among individuals who had copeptin added to either hs-cTnT or cTnT in this cohort (P <.001). These results were consistent even among early presenters (<3 hours after onset of symptoms). The dual strategy had a 2.4-fold higher level of applicability compared with the single strategy (64.6%; 95% CI, 63.0%-66.2% vs 27.9%; 95% CI, 26.2%-29.7%; P <.001).

In a sub-analysis in which the dual (n=3487) and the single (n=2540) marker strategies were compared, NPVs for rule-out of NSTEMI were not significantly different for the dual marker (99.4%; 95% CI, 99.0%-99.6%) and the single marker (99.9%; 95% CI, 99.2%-100%; P =.21). Prediction of 30-day all-cause death did not differ significantly between the 2 strategies (dual: 99.9%; 95% CI, 99.6%-100%; single: 100%; 95% CI, 98.8%-100%; P =1.0).

Limitations of this study include the low prevalence of NSTEMI and 30-day all-cause mortality in the cohort, the high amount of missing values, and the fact that data from 2 of the 5 included studies had not been previously published.

“Findings corroborate the 2015 European Society of Cardiology recommendation to use dual marker strategy for instant rule-out of NSTEMI, extending evidence to hs-cTnT,” concluded the study authors. “Novel data demonstrate a comparably safe and effective instant rule-out with Copeptin in combination with hs-cTnT versus a single marker strategy based on very low hs-cTnT but a more than twofold higher applicability of the dual marker strategy without the need to exclude very early presenters or other important subgroups.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original articles for a full list of disclosures.

Reference

Giannitsis E, Huber K, Hamm C W, et al. Instant rule‑out of suspected non‑ST‑segment elevation myocardial infarction using high‑sensitivity cardiac troponin T with Copeptin versus a single low high‑sensitivity cardiac troponin T: findings from a large pooled individual data analysis on 10,329 patients. [published online July 15, 2020] Clin Ren Cardiol. doi:10.1007/s00392-020-01712-y.