title: Ultra-Sensitive Copeptin and Cardiac Troponin in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndromes--The COPACS Study.
abstract: OBJECTIVE
  We tested the noninferiority of a fast-track rule-out protocol for the diagnosis of non-ST-segment elevation myocardial infarction vs noncoronary chest pain based on the single-sampling combined assessment of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin compared with the serial assessment of medium-sensitivity cardiac troponin I.
  
  
  METHODS
  Ultra-sensitive copeptin and medium-sensitivity cardiac troponin I levels were measured at presentation in 196 consecutive patients admitted to the emergency department for acute nontraumatic chest pain within 6 hours from symptoms onset and without ST-segment elevation on a 12-lead electrocardiogram. The diagnostic performance for non-ST-segment elevation myocardial infarction diagnosis of the dual-marker single-sampling strategy with medium-sensitivity cardiac troponin I and ultra-sensitive copeptin on admission was compared with that of the serial 0- and 3-hour medium-sensitivity cardiac troponin I sampling in reference to the adjudicated postdischarge diagnosis, using both the comparison of area under the curve (AUC) receiver operating characteristic and the McNemar chi-square test.
  
  
  RESULTS
  The diagnosis of non-ST-segment elevation myocardial infarction was adjudicated in 29 patients (14.8%). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin generated an AUC of 0.87 (95% confidence interval, 0.82-0.91), which was noninferior with respect to the 3-hour interval medium-sensitivity cardiac troponin I serial sampling (P = .194 for AUC difference). The combination of medium-sensitivity cardiac troponin I and ultra-sensitive copeptin also yielded a numerically higher diagnostic sensitivity (100% vs 89.7%; P = not significant).
  
  
  CONCLUSIONS
  A single-sampling strategy of combined ultra-sensitive copeptin and medium-sensitivity cardiac troponin I is noninferior to a 0- and 3-hour serial medium-sensitivity cardiac troponin I sampling in ruling out non-ST-segment elevation myocardial infarction and thus may allow an earlier discharge of patients who are ruled out for non-ST-segment elevation myocardial infarction (ClinicalTrials.gov Identifier NCT01962506).
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ricci
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Scala
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Massacesi
authors.affiliation: Laboratory of Biostatistics, Department of Experimental and Clinical Science, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Cremonese
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Doranna
authors.initials: D
authors.lastname: De Pace
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Irma
authors.initials: I
authors.lastname: Griffo
authors.affiliation: Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Cataldo
authors.affiliation: Department of Biomedical Sciences, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Martinotti
authors.affiliation: Emergency Department, Azienda Sanitaria Locale 2 Abruzzo Lanciano-Vasto-Chieti Hospitals, Chieti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Rotondo
authors.affiliation: Mayo Clinic, Rochester, Minn.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zimarino
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy. Electronic address: rdecater@unich.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D019210:Troponin I; C048197:copeptins
keywords: Biomarkers; Cardiac troponin; Copeptin; Early discharge; Emergency department; Myocardial infarction; Non–ST-segment elevation myocardial infarction