Copeptin improves the sensitivity of cardiac troponin in patients 70 years or older, but not enough to rule out myocardial infarction at emergency department presentation.

Abstract

We aimed to evaluate the diagnostic performance of the combination of cardiac troponin (cTn) and copeptin in a population older than 70 years of age to rule out non-ST-elevation myocardial infarction (NSTEMI) at emergency department (ED) presentation. Among 885 analyzed patients with acute chest pain presenting to the ED, 218 (25%) were aged at least 70 years. Patients with elevated copeptin values at presentation were more often aged at least 70 years and had higher blood pressure. Patients at least 70 years without NSTEMI more frequently had elevated copeptin values than younger counterparts (42 vs. 25%, P<0.0001). Bootstrap analysis for the diagnosis of NSTEMI indicated an optimal copeptin threshold value at 8.1 pmol/l in patients less than 70 years and at 10.7 pmol/l in patients at least 70 years. In patients at least 70 years, the combination of copeptin with cTnI significantly improved the sensitivity for the diagnosis of NSTEMI, at all copeptin thresholds tested, but the negative predictive value remained below 95%. The combination of copeptin with conventional cTnI significantly improved sensitivity for the diagnosis of NSTEMI in patients at least 70 years. However, this improvement was not enough to rule out NSTEMI with a single draw strategy at ED presentation.