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The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin |
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| Authors: | Carsten Stengaard Jacob T. Sørensen Søren A. Ladefoged Jens F. Lassen Martin B. Rasmussen Claus Kjær Pedersen |
| Affiliation: | 1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark;2. Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark;3. Department of Cardiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark;4. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark |
| Abstract: | Purpose: In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase. Materials and methods: In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model. Multivariable Cox regression modelling was used to estimate the predictive value of both biomarkers. Results: In total, 178 (19%) cases had AMI. The AUC for hs-cTnT was 0.81. Adding copeptin increased the AUC to 0.85 (p?=?0.004) and the combined model allowed a prehospital rule-out of 45% of cases without AMI (negative predictive value, NPV 98%). Both biomarkers are highly predictive of outcome. Conclusions: A future application of hs-cTnT and copeptin measurement, performed already in the prehospital phase, could potentially improve the prehospital diagnostic and prognostic classification of patients with a suspected AMI. |
| Keywords: | Acute coronary syndrome troponin copeptin prehospital emergency care diagnosis prognosis biomarkers |