Author + information
- Mikkel M. Schoos,
- Martin L. Nielsen,
- Jøgen Thode,
- Steen I. Hansen,
- Kasper Iversen,
- Peter Clemmensen and
- Rolf Steffensen
Recent clinical trials show that adding copeptin or heart-type fatty acid-binding protein (H-FABP) to conventional cardiac troponins (cTn) assays improve diagnostic performances. Whether copeptin and H-FABP add information to high-sensitivity cTn (hscTn) is only sparsely investigated.
We prospectively evaluated the diagnostic accuracy by the area under the curve (AUC) of hscTnT (Roche Diagnsotics), hscTnI (Siemens Vista), Copeptin (Brahms Thermo-Fisher Scientific) and H-FABP (Randox Laboratories) at admission in 601 consecutive unselected chest pain patients with 59 (9.8 %) acute myocardial infarctions (MI).
In the overall population, diagnostic performances for hscTnT (AUC 0.923) and hscTnI (AUC 0.922) were equipotent and superior to copeptin (AUC 0.729) and H-FABP (AUC 0.755) (p<0.001). ROC-optimized cut-off values were 5.65 µg/L for H-FABP and 18.35 pmol/L for copeptin. Combining copeptin or H-FABP with either hscTnT or hscTnI did not improve AUC, but increased NPV at the expense of a marked specificity drop. The combination of hscTnI+H-FABP yielded the numerically highest diagnostic performance (AUC 0.933) but did not significantly increase AUC over hscTnI or hscTnT alone. HscTnI+H-FABP resulted in 98.2 % sensitivity and 99.7 % NPV for ‘ruling out’ and when only considering hscTnI an 87 % specificity and 42.6 % PPV for ‘ruling in’ with one single sample at admission. In 159 patients with symptom onset <6 hours, hscTnI (AUC 0.912) and hscTnT (AUC 0.918) were equipotent and superior to copeptin (AUC 0.734) (p=0.012 and p=0.004), but not to H-FABP (AUC 0.782) (p=0.127 and p=0.063). The combination of hscTni+H-FABP (AUC 0.943) was significantly superior to copeptin (p=0.009), H-FABP (p=0.033), hscTnI+copeptin (AUC 0.887) (p=0.046) and marginally to hscTnT+copeptin (AUC 0.908) (p = 0.062), but not to hscTnI (p=0.173) or hscTnT (p=0.230) alone.
In a single sample strategy, admission hscTns are equipotent and superior to copeptin and H-FABP. HscTnT has slightly better ‘ruling out’ and hscTnI better ‘ruling in’ capacities in diagnosing MI. The numerically best diagnostic strategy was regardless of symptom onset the combination of hscTnI+H-FABP.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: The Blood Tells a Story: Coeptin, Fatty Acid Binding Protein, NT-Pro BNP and More
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1259-206
- 2013 American College of Cardiology Foundation