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The combination of high sensitivity troponin T and copeptin facilitates early rule-out of ACS: a prospective observational study

Overview of attention for article published in BMC Cardiovascular Disorders, June 2013
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Title
The combination of high sensitivity troponin T and copeptin facilitates early rule-out of ACS: a prospective observational study
Published in
BMC Cardiovascular Disorders, June 2013
DOI 10.1186/1471-2261-13-42
Pubmed ID
Authors

Johan Thelin, Catharina Borna, David Erlinge, Bertil Öhlin

Abstract

BACKGROUND: The combination of the new high sensitivity troponin T (hsTnT) assays and copeptin, a biomarker of endogenous stress, has been suggested to have the potential of early rule-out of acute coronary syndrome (ACS). The aim of this study was to examine the ability of this combination to rule out ACS in patients presenting with chest pain and to compare the diagnostic performance to hsTnT alone. METHOD: In this prospective observational study, patients with chest pain admitted for observation were consecutively included. Patients presenting with ST elevation were excluded. Copeptin and hsTnT were analyzed at admission and hsTnT was thereafter determined approximately every 3rd hour as long as clinically indicated. The follow-up period was 60 days. A combined primary endpoint of ACS, non-elective percutanous coronary intervention, non-elective coronary artery bypass surgery and death of all causes was used. RESULTS: 478 patients were included. 107 (22%) patients were diagnosed with ACS during hospital stay. 70 (14%) had non-ST-segment elevation myocardial infarction (NSTEMI) and 37 (8%) had unstable angina pectoris (UAP).The combination of hsTnT >14 ng/L or copeptin >=14 pmol/L at admission identified ACS with a higher sensitivity than hsTnT alone: 0.83 (95% confidence interval (CI): 0.74-0.89) versus 0.69 (95% CI: 0.59-0.77), p <0.001. Negative predictive values (NPV) 91% (95% CI: 86-94) versus 89% (95% CI: 84-92). A repeated hsTnT analyzed 3-4 hours after admission resulted in a sensitivity of: 0.77 (95% CI: 0.65-0.86), p =0.031 for comparison with the combination analyzed at admission. CONCLUSIONS: In patients presenting with chest pain admitted for observation, the combination of hsTnT and copeptin analyzed at admission had a significantly higher sensitivity to diagnose ACS than hsTnT alone. We report a sensitivity of 83% and a NPV of 91% for the combination of hsTnT and copeptin and we conclude that biomarkers alone are not sufficient to rule out ACS. However, the combination of hsTnT and copeptin seems to have a significantly higher sensitivity to identify ACS than a repeated hsTnT test, and thus enables an earlier risk stratification of chest pain patients. This can be time-saving and beneficial for the individual patient by contributing to early decisions on treatment, need of further assessment and level of care.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 36 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 3%
Turkey 1 3%
Unknown 34 94%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 6 17%
Researcher 6 17%
Student > Master 4 11%
Student > Bachelor 4 11%
Student > Doctoral Student 3 8%
Other 8 22%
Unknown 5 14%
Readers by discipline Count As %
Medicine and Dentistry 23 64%
Nursing and Health Professions 2 6%
Chemistry 1 3%
Social Sciences 1 3%
Unknown 9 25%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 June 2013.
All research outputs
#18,340,605
of 22,712,476 outputs
Outputs from BMC Cardiovascular Disorders
#1,097
of 1,595 outputs
Outputs of similar age
#147,794
of 196,782 outputs
Outputs of similar age from BMC Cardiovascular Disorders
#12
of 19 outputs
Altmetric has tracked 22,712,476 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,595 research outputs from this source. They receive a mean Attention Score of 3.8. This one is in the 17th percentile – i.e., 17% of its peers scored the same or lower than it.
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We're also able to compare this research output to 19 others from the same source and published within six weeks on either side of this one. This one is in the 5th percentile – i.e., 5% of its contemporaries scored the same or lower than it.