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首页> 外文期刊>Clinical cardiology. >Diagnostic Performance of Copeptin in Patients With Acute Nontraumatic Chest Pain: BWH-TIMI ED Chest Pain Study
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Diagnostic Performance of Copeptin in Patients With Acute Nontraumatic Chest Pain: BWH-TIMI ED Chest Pain Study

机译：Copeptin在急性非创伤性胸痛患者中的诊断性能：BWH-TIMI ED胸痛研究

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BackgroundArginine-vasopressin (AVP) is an acute marker of physiologic stress. Copeptin is the C-terminal fragment of vasopressin precursor hormone that is more easily measured than AVP. Studies assessing the utility of copeptin in the diagnosis of myocardial infarction (MI) have demonstrated mixed results.HypothesisThe aim of this study was to test the hypothesis that copeptin improves diagnostic performance when added to troponin for detecting MI in patients presenting to the emergency department with nontraumatic chest pain.MethodsWe measured copeptin, local cardiac troponin I (local cTnI), and a contemporary sensitive cardiac troponin I (sensitive cTnI) at presentation and serially in patients who presented with acute chest pain. A copeptin cutoff of 14 pmol/L was utilized.ResultsMI was diagnosed in 25.7% of patients. Noncoronary acute cardiopulmonary causes of chest pain occurred in 12.8%. Patients with MI had significantly higher copeptin levels than patients with noncardiac chest pain (P 0.001). The area under the receiver operating characteristic curve (AUC) for copeptin was 0.60 (95% confidence interval: 0.54-0.66), significantly less than the AUC for local cTnI (0.92) or sensitive cTnI (0.96). The combination of copeptin with either the local or sensitive troponin assay (c-statistics 0.92 and 0.95, respectively) did not significantly improve the AUC as compared to either troponin assay alone. This finding persisted in the subgroup of early presenters (≤6 hours from symptom onset).ConclusionsCopeptin did not improve the diagnostic performance for detecting MI when used alone or in combination with a contemporary sensitive cTnI assay, though our cohort had relatively few early presenters.
机译：背景精氨酸加压素（AVP）是生理应激的急性指标。肽肽是血管加压素前体激素的C末端片段，比AVP更容易测量。评估肽素在心肌梗塞（MI）诊断中的实用性的研究结果好坏参半。假设本研究的目的是检验以下假设，即肽素与肌钙蛋白联用可改善诊断性心肌梗死患者的心肌梗死诊断性能。方法我们在出现急性胸痛的患者中和就诊时连续测量肽素，局部心脏肌钙蛋白I（局部cTnI）和当代敏感性心脏肌钙蛋白I（敏感cTnI）。使用的肽素截止值为14 pmol / L。结果诊断为MI的患者占25.7％。非冠心病引起的急性心肺性胸痛发生率为12.8％。 MI患者的肽素水平显着高于非心源性胸痛患者（P <0.001）。肽素的受体工作特征曲线（AUC）下的面积为0.60（95％置信区间：0.54-0.66），显着小于局部cTnI的AUC（0.92）或敏感cTnI的AUC（0.96）。与单独的肌钙蛋白测定相比，肽素与局部或敏感肌钙蛋白测定的组合（分别为c统计0.92和0.95）没有显着改善AUC。这一发现持续存在于早期呈报者的亚组中（症状发作后≤6小时）。结论虽然我们的队列研究者中早期呈报者相对较少，但与单独使用或与现代敏感性cTnI检测结合使用时，肽素并不能提高诊断MI的诊断性能。

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