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PLoS One. 2018 Jul 6;13(7):e0200379. doi: 10.1371/journal.pone.0200379. eCollection 2018.

Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis.

Shin H1, Jang BH2, Lim TH1,3, Lee J1, Kim W4,5, Cho Y4,5, Ahn C5,6, Choi KS7.

Author information

1
Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.
2
Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea.
3
Convergence Technology Center for Disaster Preparedness, Hanyang University, Seoul, Korea.
4
Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea.
5
Department of Biomedical Engineering, Graduate School of Medicine, Hanyang University, Seoul, Korea.
6
Department of Emergency Medicine, Armed Forces Yangju Hospital, Yangju, Korea.
7
Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea.

Abstract

INTRODUCTION:

This study aimed to determine the diagnostic accuracy of adding copeptin to cardiac troponin (cTn) on admission to the emergency department (ED) for non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone.

MATERIALS AND METHODS:

A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed (search date: April 13, 2018). Primary studies were included if they accurately reported on patients with symptoms suggestive of acute myocardial infarction and measured both cTn alone and cTn with copeptin upon admission to the ED. The patients with evidence of ST elevation myocardial infarction were excluded. To assess the risk of bias for the included studies, the QUADAS-2 tool was used.

RESULTS:

The study participants included a total of 7,998 patients from 14 observational studies. The addition of copeptin to cTn significantly improved the sensitivity (0.81 [0.74 to 0.87] vs. 0.92 [0.89 to 0.95], respectively, p <0.001) and negative predictive value (0.96 [0.95 to 0.98] vs. 0.98 [0.96 to 0.99], respectively, p <0.001) at the expense of lower specificity (0.88 [0.80 to 0.97] vs. 0.57 [0.49 to 0.65], respectively, p <0.001) compared to cTn alone. Furthermore, adding copeptin to cTn showed significantly lower diagnostic accuracy for NSTEMI compared to cTn alone (0.91[0.90 to 0.92] vs. 0.85 [0.83 to 0.86], respectively, p < 0.001).

CONCLUSIONS:

Adding copeptin to cTn improved the sensitivity and negative predictive value for the diagnosis of NSTEMI compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the ED.

PMID:
29979797
PMCID:
PMC6034895
DOI:
10.1371/journal.pone.0200379
[Indexed for MEDLINE]
Free PMC Article

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