Adding stress biomarkers to high-sensitivity cardiac troponin for rapid non-ST-elevation myocardial infarction rule-out protocols.

Abstract

AIMS:

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.

METHODS AND RESULTS:

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.

CONCLUSION:

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.

• Authors: Ingar Ziad Restan, Ana Yufera Sanchez, Ole-Thomas Steiro, Pedro Lopez-Ayala, Hilde L Tjora, Jørund Langørgen, Torbjørn Omland, Jasper Boeddinghaus, Thomas Nestelberger, Luca Koechlin, Paul Collinson, Rune Bjørneklett, Kjell Vikenes, Heidi Strand, Øyvind Skadberg, Øistein R Mjelva, Alf Inge Larsen, Vernon V S Bonarjee, Christian Mueller, Kristin M Aakre
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 11 Issue 3 Pg. 201-212 (Mar 16 2022) ISSN: 2048-8734 [Electronic] England
• PMID: 35024819 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Chemical References

• Biomarkers
• Troponin I
• Troponin T

Topics

• Biomarkers
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis)
• Non-ST Elevated Myocardial Infarction (diagnosis)
• Prospective Studies
• Troponin I
• Troponin T