Diagnostic performance and risk assessment of combined copeptin and high-sensitivity cardiac troponin I in Chinese emergency department.

BACKGROUND

Rapid and early identification of acute myocardial infarction (AMI) is crucial for initiating timely treatment and assessing post-discharge risks. Copeptin's unique release profile may help detect early myocardial damage, particularly when high-sensitivity cardiac troponin I (hs-cTnI) is undetectable. However, there is a limited understanding of copeptin's application in the Chinese population, highlighting the need for further research.

METHODS

A prospective cohort study was conducted, enrolling 414 consecutive patients presenting to the emergency department (ED) within 6 h of chest pain onset. Baseline clinical characteristics were recorded, and copeptin and hs-cTnI levels were measured from the initial blood draw. Patients were followed for 180 days to determine the occurrence of major adverse cardiovascular events (MACE). The final diagnosis was independently adjudicated by a panel of cardiologists blinded to copeptin results.

RESULTS

Of 414 Chinese patients, 112 (27.05 %) had AMI. In hs-cTnI-undetectable patients, median copeptin was 290 pmol/L (IQR: 211-547) in STEMI and 130 pmol/L (IQR: 47.8-184) in NSTEMI. DBRS (copeptin/hs-cTnI dual-negative biomarker rule-out strategy) had higher AUC than single biomarkers (P < 0.05), with 100 % NPV (95 % CI: 95.86-100) for chest pain (3/6 h). Elevated copeptin (Hazard Ratio (HR) 3.65, 95 % CI: 2.35-5.67) and hs-cTnI (HR 1.69, 95 % CI: 1.36-2.10) independently predicted 180-day MACE (P < 0.001).

CONCLUSIONS

In Chinese patients, DBRS provided a safe and effective strategy for ruling out AMI. In addition, Combined negative results predicted safer 180-day post-discharge outcomes.