title: The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin.
abstract: OBJECTIVE
  In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase.
  
  
  METHODS
  In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model. Multivariable Cox regression modelling was used to estimate the predictive value of both biomarkers.
  
  
  RESULTS
  In total, 178 (19%) cases had AMI. The AUC for hs-cTnT was 0.81. Adding copeptin increased the AUC to 0.85 (p = 0.004) and the combined model allowed a prehospital rule-out of 45% of cases without AMI (negative predictive value, NPV 98%). Both biomarkers are highly predictive of outcome.
  
  
  CONCLUSIONS
  A future application of hs-cTnT and copeptin measurement, performed already in the prehospital phase, could potentially improve the prehospital diagnostic and prognostic classification of patients with a suspected AMI.
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Stengaard
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Sørensen
authors.affiliation: b Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren A
authors.initials: SA
authors.lastname: Ladefoged
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.|c Department of Cardiology , Rigshospitalet Copenhagen University , Copenhagen , Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Rasmussen
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Claus Kjær
authors.initials: CK
authors.lastname: Pedersen
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.|d Department of Cardiology , Bern University Hospital , Bern , Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Ayer
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thygesen
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins
keywords: Acute coronary syndrome; biomarkers; copeptin; diagnosis; prehospital emergency care; prognosis; troponin