Is high-sensitivity troponin, alone or in combination with copeptin, sensitive enough for ruling out NSTEMI in very early presenters at admission? A post hoc analysis performed in emergency departments
BMJ Open Jun 20, 2019
Chenevier-Gobeaux C, et al. - Through a post hoc analysis of three prospective studies, researchers investigated if copeptin and high-sensitivity cardiac troponin (HS-cTn) assays could improve the early detection of non-ST-segment elevation myocardial infarction (NSTEMI). The study sample consisted of 449 patients who presented to the emergency department for chest pain onset (CPO) of < 6 hours. Through CPO categories, diagnostic accuracies of cardiac troponin I (cTnI), cTnI + copeptin and high sensitivity-cardiac troponin T (HS-cTnT) were lower. Hence, a single measurement of HS-cTn, alone or in combination with copeptin at admission, couldn't be concluded as safe enough for ruling out NSTEMI in very early presenters (with CPO < 2 hours). Furthermore, emergency physicians might not be able to rule out NSTEMI in very early presenters with a single low value of HS-cTnT and/or copeptin at presentation.
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