Startseite Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department1)
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Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department1)

  • Philipp Bahrmann EMAIL logo , Anke Bahrmann , Ole-A. Breithardt , Werner G. Daniel , Michael Christ , Cornel C. Sieber und Thomas Bertsch
Veröffentlicht/Copyright: 9. Januar 2013
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 51 Heft 6

Abstract

Background: Identifying older patients with non-ST- elevation myocardial infarction (NSTEMI) within the very large proportion with elevated high-sensitive cardiac troponin T (hs-cTnT) is a diagnostic challenge because they often present without clear symptoms or electrocardiographic features of acute coronary syndrome to the emergency department (ED). We prospectively investigated the diagnostic and prognostic performance of copeptin ultra-sensitive (copeptin-us) and hs-cTnT compared to hs-cTnT alone for NSTEMI at prespecified cut-offs in unselected older patients.

Methods: We consecutively enrolled 306 non-surgical patients ≥70 years presenting to the ED. In addition to clinical examination, copeptin-us and hs-cTnT were measured at admission. Two cardiologists independently adjudicated the final diagnosis of NSTEMI after reviewing all available data. All patients were followed up for cardiovascular-related death within the following 12 months.

Results: NSTEMI was diagnosed in 38 (12%) patients (age 81±6 years). The combination of copeptin-us ≥14 pmol/L and hs-cTnT ≥0.014 µg/L compared to hs-cTnT ≥0.014 µg/L alone had a positive predictive value of 21% vs. 19% to rule in NSTEMI. The combination of copeptin-us <14 pmol/L and hs-cTnT <0.014 µg/L compared to hs-cTnT <0.014 µg/L alone had a negative predictive value of 100% vs. 99% to rule out NSTEMI. Hs-cTnT ≥0.014 µg/L alone was significantly associated with outcome. When copeptin-us ≥14 pmol/L was added, the net reclassification improvement for outcome was not significant (p=0.809).

Conclusions: In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

Keywords: aged; copeptins; emergencies; myocardial infarction; troponin
Corresponding author: Philipp Bahrmann, MD, FESC, Institute for Biomedicine of Aging, Friedrich-Alexander-University, Heimerichstrasse 58, 90419 Nuremberg, Germany, Phone: +49 911 398112748, Fax: +49 911 398 2117

Routine analysis and sample management were performed by Ruth Bach, Elke Pröbster and their laboratory team. Copeptin-us and cystatin c were measured by Christine Aschenneller. Their work is gratefully acknowledged. ClinicalTrials.gov Identifier: NCT01370395.

Conflict of interest statement

Authors’ conflict of interest disclosures: The authors stated that there are no conflicts of interest regarding the publication of this article.

Research funding: P.B. is a research fellow of the Robert Bosch Foundation, Stuttgart, Germany. The Robert Bosch Foundation funded this study but played no role in the design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Employment or leadership: None declared.

Honorarium: P.B. received honorarium from B.R.A.H.M.S. Biomarkers, Clinical Diagnostics Division, Thermo Fisher Scientific, Hennigsdorf, Germany. M.C. and T.B. received honoraria from Roche Diagnostics, Mannheim, Germany.

  1. 1)

    Dedicated in grateful memory to Prof. Dr. mult. Hermann Wisser who passed away in November 2012.

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Received: 2012-06-21
Accepted: 2012-11-09
Published Online: 2013-01-09
Published in Print: 2013-06-01

©2013 by Walter de Gruyter Berlin Boston

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  41. Do laboratories follow heart failure recommendations and guidelines and did we improve? The CARdiac MArker Guideline Uptake in Europe (CARMAGUE)
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  43. Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department1)
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https://doi.org/10.1515/cclm-2012-0401
Schlagwörter für diesen Artikel
aged; copeptins; emergencies; myocardial infarction; troponin

Artikel in diesem Heft

  1. Letters to the Editor
  2. Evaluation of a novel room temperature RNA storage tube for use in a real-time quantitative PCR assay
  3. Evaluation of the Universal Master Mix (STAT-NAT DNA-Mix) for reliable molecular testing
  4. HbA1c: performance of the Sebia Capillarys 2 Flex Piercing
  5. A case of monoclonal gammopathy of undetermined significance (MGUS): type IgD-lambda
  6. Evidence-based use of serum protein electrophoresis in laboratory medicine
  7. Plasma volume shifts during multiday racing
  8. Structured handoff at shift change in a clinical laboratory increases patient safety
  9. Instrument-dependent interference of Howell-Jolly bodies in reticulocyte enumeration
  10. Reply to Gore et al.: Plasma volume shift during multiday racing
  11. Recommendations for appropriate serum electrophoresis requests: the Italian approach
  12. Masthead
  13. Masthead
  14. Editorials
  15. Biomarkers for sepsis: an unfinished journey
  16. Laboratory demand management of repetitive testing – time for harmonisation and an evidenced based approach
  17. Reviews
  18. Non-invasive prenatal diagnostics of aneuploidy using next-generation DNA sequencing technologies, and clinical considerations
  19. The diagnostic utility of brain natriuretic peptide in heart failure patients presenting with acute dyspnea: a meta-analysis
  20. Opinion Paper
  21. Opinion paper on innovative approach of biomarkers for infectious diseases and sepsis management in the emergency department
  22. Genetics and Molecular Diagnostics
  23. Microarray with LNA-probes for genotyping of polymorphic variants of Gilbert’s syndrome gene UGT1A1(TA)n
  24. Selection of the optimal manual method of cell free fetal DNA isolation from maternal plasma
  25. A multiplex assay to rapidly exclude HLA-DQ2.5 and HLA-DQ8 expression in patients at risk for celiac disease
  26. Low cost biosensor-based molecular differential diagnosis of α-thalassemia (Southeast Asia deletion)
  27. General Clinical Chemistry and Laboratory Medicine
  28. Managing laboratory test ordering through test frequency filtering
  29. Critical review of laboratory investigations in clinical practice guidelines: proposals for the description of investigation
  30. Long-term stability of laboratory tests and practical implications for quality management
  31. Coffee consumption, serum γ-glutamyltransferase, and glucose tolerance status in middle-aged Japanese men
  32. Biological variation and prognosis usefulness of new biomarkers in liver transplantation
  33. Switching between parathormone (PTH) assays: the impact on the diagnosis of renal osteodystrophy
  34. A comparison between two different in vitro basophil activation tests for gluten- and cow’s milk protein sensitivity in irritable bowel syndrome (IBS)-like patients
  35. A proficiency testing program of hemoglobin analysis in prevention and control of severe hemoglobinopathies in Thailand
  36. Advancing haemostasis automation – successful implementation of robotic centrifugation and sample processing in a tertiary service hospital
  37. ADAM12s and PP13 as first trimester screening markers for adverse pregnancy outcome
  38. Analysis of serous body fluids using the CELL-DYN Sapphire hematology analyzer
  39. Cancer Diagnostics
  40. Association and prognostic value of serum inflammation markers in patients with leukoplakia and oral cavity cancer
  41. Do laboratories follow heart failure recommendations and guidelines and did we improve? The CARdiac MArker Guideline Uptake in Europe (CARMAGUE)
  42. Cardiovascular Diseases
  43. Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department1)
  44. Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality
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