Dual marker rule-out of non-AMI acute cardiovascular conditions in chest pain patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Danish Heart foundation Independent Research Fund Denmark Background A dual marker strategy combining prehospital copeptin and in-hospital hs-cTnT has shown promising results in early rule out of AMI. This combination may also allow for rule out of other life-threatening conditions in patients presenting with chest pain. Copeptin is a nonspecific marker of endogenous stress and elevated levels would be expected in life-threatening conditions causing haemodynamic instability. Elevated troponin levels due to secondary acute myocardial injury is often seen in life-threatening conditions (e.g. pulmonary embolism and aortic dissection). Purpose To evaluate if an accelerated DMS combining prehospital copeptin and 1st in-hospital hs-cTnT can rule out other life threatening conditions than AMI in patients with symptoms suggestive of AMI. Methods The diagnostic performance of the accelerated DMS regarding serious cardiovascular conditions other than AMI was compared in patients with suspected AMI from a randomized, controlled, multicentre trial. Serious cardiovascular conditions included pulmonary embolism, pneumothorax, ventricular tachycardia, and aortic dissection. Diagnoses were retrieved from the Danish National Registry of Patients. Serious conditions were ruled out if copeptin was below 9.8 pmol/L (95th percentile) and troponin T was below 14 ng/L (99th percentile). Results In 3,426 with both prehospital copeptin and 1st in-hospital troponin T available, 39 patients received a diagnosis of one of the predefined serious cardiovascular condition during index admission. The accelerated DMS performed with a sensitivity of 82%, a specificity of 48% and a NPV of 99.5%. Conclusion(s) Accelerated DMS did not perform with acceptable sensitivity for the rule out of other life-threatening conditions in patients with suspected AMI.