Copeptin Adds No Value to High-Sensitivity Troponin at Limit-of-Detection Thresholds for NSTEMI Rule-Out
This meta-analysis of 13 studies and nearly 9,000 patients finds that adding copeptin to high-sensitivity troponin improves NSTEMI rule-out sensitivity when using the 99th percentile threshold, but at a substantial cost in specificity. Critically, when hs-cTn is used at its limit of detection, copeptin provides no additional diagnostic value, arguing against dual-marker strategies where modern hs-cTn assays are available.
The original study
Copeptin with high-sensitivity cardiac troponin to rule out non-ST-elevation myocardial infarction early on: A systematic review and meta-analysis.
- Authors
- Mu D, Zhong J, Li L, Cheng J, Zou Y, Qiu L, et al.
- Journal
- Clinical biochemistry
- Type
- Meta-Analysis, Systematic Review, Journal Article
- PMID
- 36435204
Original abstract
High-sensitivity cardiac troponin (hs-cTn) with copeptin in rapidly ruling out non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We aimed to evaluate the diagnostic accuracy of this combination compared to hs-cTn alone. A literature search of electronic databases was performed from inception to 26 March 2022. Primary studies that evaluated the diagnostic accuracy of hs-cTn with and without copeptin in patients with NSTEMI were eligible. The reference standard consisted of all available medical results, including a significant rise or fall of cTn with at least one value above the 99th percentile of the reference population. The QUality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the included studies. Thirteen studies involving 8,966 patients, 1,405 of whom were diagnosed with NSTEMI (prevalence, 15.67 %), were included. Combining copeptin with hs-cTn (99th percentile of the healthy population as the threshold) at admission improved the sensitivity from 0.89 to 0.96 (95 % confidence interval [CI] 0.84-0.93 vs 0.93-0.98); the specificity reduced from 0.79 to 0.56 (95 % CI 0.71-0.86 vs 0.51-0.60). In five studies with 6,073 participants (900 NSTEMI), the hs-cTn alone (with 'very low' or limit of detection [LoD] threshold) had higher diagnostic sensitivity than the dual-marker strategy (0.98 vs 0.96). Combining copeptin with hs-cTn (99th percentile of the population as the threshold) at admission improved sensitivity in NSTEMI identification at the expense of specificity. However, with the LoD threshold for hs-cTn, copeptin had no additional value, deterring the widespread use of copeptin if the hs-cTn assay is clinically available.