title: Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This systematic review aimed to investigate the diagnostic accuracy of combined cardiac troponin (cTn) and copeptin assessment in comparison to cTn alone for early rule-out of acute myocardial infarction (AMI).
  
  
  METHODS
  Primary studies were eligible if they evaluated diagnostic accuracy for cTn with and without copeptin in patients with symptoms suggestive of AMI. AMI was defined according to the universal definition, using detection of cTn as a marker for myocardial necrosis. Eligible studies were identified by searching electronic databases (Medline, EMBASE, Science Citation Index Expanded, CINAHL, Pascal, and Cochrane) from inception to March 2013, reviewing conference proceedings and contacting field experts and the copeptin manufacturer.
  
  
  RESULTS
  In 15 studies totalling 8740 patients (prevalence of AMI 16%), adding copeptin improved the sensitivity of cTn assays (from 0.87 to 0.96, p=0.003) at the expense of lower specificity (from 0.84 to 0.56, p<0.001). In 12 studies providing data for 6988 patients without ST-segment elevation, the summary sensitivity and specificity estimates were 0.95 (95% CI 0.89 to 0.98) and 0.57 (95% CI 0.49 to 0.65) for the combined assessment of cTn and copeptin. When a high-sensitivity cTnT assay was used in combination with copeptin, the summary sensitivity and specificity estimates were 0.98 (95% CI 0.96 to 1.00) and 0.50 (95% CI 0.42 to 0.58).
  
  
  CONCLUSIONS
  Despite substantial between-study heterogeneity, this meta-analysis demonstrates that copeptin significantly improves baseline cTn sensitivity. Management studies are needed to establish the effectiveness and safety of measuring copeptin in combination with high-sensitivity cTnT for early rule-out of AMI without serial testing.
authors.affiliation: University Hospital, Clermont-Ferrand, France.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Raskovalova
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.forename: Christian
authors.initials: C
authors.lastname: Folli
authors.forename: Davide
authors.initials: D
authors.lastname: Giavarina
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: José
authors.initials: J
authors.lastname: Labarère
mesh_terms: D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors; D012372:ROC Curve; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; D019210:Troponin I; D020107:Troponin T; C048197:copeptins
keywords: copeptin; diagnostic accuracy; myocardial infarction; troponin