Interest of the combination of high-sensitivity troponine and copeptin in diagnosis of non ST elevation myocardial infarction

The diagnosis of non ST elevation myocardial infarction (NSTEMI) is very important for the emergency doctor. According to the literature copeptin, a marker of the endogenous stress, combined with troponin could be of interest in this diagnosis. The objective of the study was to investigate the association of high-sensitivity (HS) troponin and copeptine to eliminate the diagnosis of NSTEMI or unstable angina (UA) in patients arriving in Casualty with a thoracic pain. This prospective study included patients showing up at Casualty with a thoracic pain less than 12 hours old. Copeptin was measured by the BRAHMS method at admission and HS troponin was measured at admission, after 2 and 6 hours. The patients also had a follow-up phone call after 3 months. The study included 114 patients with an average age of 54.6 years. NSTEMI was diagnosed for 8.8% of them and UA for 6.1%. The patients presenting NSTEMI or UA had a copeptin rate at admission higher than the others (24.7 pmol/L versus 7.1; p < 0.002). The negative predictive value of the association of HS troponin and copeptin was 95% whereas the sensitivity was 76.5% and the specificity 78.4%. The ROC curve analysis of the copeptin results brought to light a positivity limit which would have been more successful at 10.3 pmol/L than at 14.0. The association of copeptin and HS troponin can be useful to exclude the diagnosis of NSTEMI and favours faster treatment in Casualty.