在急诊科患者中早期排除急性心肌梗死：入院时联合检测高敏心肌肌钙蛋白 T 和超敏 copeptin 的价值。

Early rule out of acute myocardial infarction in ED patients: value of combined high-sensitivity cardiac troponin T and ultrasensitive copeptin assays at admission.

机构信息

Département des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, 34295-MONTPELLIER Cedex 5 France.

出版信息

Am J Emerg Med. 2013 Sep;31(9):1302-8. doi: 10.1016/j.ajem.2013.04.033. Epub 2013 Jun 29.

DOI:10.1016/j.ajem.2013.04.033

PMID:23816196

Abstract

OBJECTIVE

We sought to evaluate the added value of ultrasensitive copeptin (us-copeptin) for early rule out of acute myocardial infarction in a prospective cohort of emergency department (ED) patients with acute chest pain.

METHODS

This was a prospective study including consecutive patients with acute chest pain presenting to the ED within 12 hours of symptom onset. High-sensitivity cardiac troponin T (hs-cTnT, Roche Diagnostics, Meylan, France) and us-copeptin (ThermoFisher Scientific, Clichy, France) were blindly assayed from venous blood samples obtained at admission. Diagnosis was made by 2 ED physicians using all available data and serial cardiac troponin I as the biochemical standard. Diagnostic performances of us-copeptin combined with hs-cTnT were assessed using logistic regression. Analysis was conducted in all patients and in patients without ST-elevation myocardial infarction.

RESULTS

A total of 194 patients were included (age, 61 [48-75] years; male sex, 63%). Acute myocardial infarction occurred in 52 (27%) patients, including non-ST-elevation myocardial infarction (NSTEMI) in 25 (13%). Patients with acute myocardial infarction had higher levels of hs-cTnT (50 [95% confidence interval, 19-173] ng/L) and us-copeptin (30 [13-113] pmol/L) at admission compared with those without (P < .05). Combination of markers significantly improved receiver operating characteristic area under the curve (from 0.89 [0.85-0.92] for hs-cTnT alone to 0.93 [0.89-0.97], P = .018). Sensitivity and negative predictive value were increased, particularly for NSTEMI diagnosis (sensitivity, 76% [54.9-90.6] to 96% [79.6-99.9]; negative predictive value, 95% [90.4-98.3] to 98.9% [94.2 to 100]).

CONCLUSION

Assessment of us-copeptin combined with hs-cTnT on ED admission could allow safe and early rule out of NSTEMI for patients with negative results on both markers and help identify patients who may be suitable for discharge.

摘要

目的

我们旨在评估超敏 copeptin（us-copeptin）在急诊（ED）有急性胸痛的急性心肌梗死患者的前瞻性队列中的早期排除急性心肌梗死的附加价值。

方法

这是一项前瞻性研究，包括发病 12 小时内出现急性胸痛的连续 ED 患者。从入院时采集的静脉血样中盲法检测高敏肌钙蛋白 T（hs-cTnT，罗氏诊断公司，Meylan，法国）和 us-copeptin（ThermoFisher Scientific，Clichy，法国）。两名 ED 医师使用所有可用数据和连续肌钙蛋白 I 作为生化标准来诊断。使用逻辑回归评估 us-copeptin 与 hs-cTnT 联合使用的诊断性能。在所有患者和无 ST 段抬高心肌梗死患者中进行分析。

结果

共纳入 194 例患者（年龄 61[48-75]岁；男性 63%）。52 例（27%）患者发生急性心肌梗死，其中包括非 ST 段抬高心肌梗死（NSTEMI）25 例（13%）。与无急性心肌梗死的患者相比，发生急性心肌梗死的患者入院时 hs-cTnT（50[95%置信区间，19-173]ng/L）和 us-copeptin（30[13-113]pmol/L）水平更高（P<.05）。联合标志物显著提高了接受者操作特征曲线下面积（从单独 hs-cTnT 的 0.89[0.85-0.92]提高至 0.93[0.89-0.97]，P=.018）。灵敏度和阴性预测值增加，特别是对 NSTEMI 诊断（灵敏度，76%[54.9-90.6]至 96%[79.6-99.9]；阴性预测值，95%[90.4-98.3]至 98.9%[94.2-100]）。