Table 2.
Copeptin studies evaluating different copeptin cutoff values
| Study | MI prevalence | Troponin assay | Copeptin assay | NPVa | Comments |
|---|---|---|---|---|---|
| Giannitsis et al. [9•] | CPU population (single-center study). AMI 27.0 % (136/503).NSTEMI 17.3 % (87/503) | hsTnT (Roche Diagnostics) <14 ng/l | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) <14 pmol/l | hsTnT alone 95.8 % (92.6-97.9 %). hsTnT plus copeptin 98.6 % (95.8-99.7 %). NSTEMI only, hsTnT plus copeptin 99.03 % (96.6-99.9 %) | 45.5 % of patients enrolled within 3 h after onset of symptoms; 19.5 % enrolled within 3–6 h after onset of symptoms |
| Potocki et al. [10•] | ED population (substudy of a multicenter study). AMI 15.7 % (184/1,170). Patients with preexisting CAD, AMI 18.0 % (78/433) | TnT (Roche Diagnostics, 4th generation) cutoff 0.01 μg/l. hsTnT (Roche Diagnostics) cutoff 14 ng/l | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) 9 pmol/l | Patients with preexisting CAD, TnT alone 95 % (92.1-97.0 %), TnT plus copeptin 99.5 % (97.1-99.9 %), hsTnT alone 97.7 % (94.8-99.3 %), hsTnT plus copeptin 99.3 (96.3-99.9 %) | APACE substudy evaluating patients with preexisting CAD |
| Ray et al. [11•] | Pooled, selected ED population with history of CAD. AMI 8.0 % (36/451), NSTEMI 6.7 % (30/451) | 2 EDs cTnI (Siemens Healthcare), 1 ED cTnI (Abbott Laboratories). Cutoffs below threshold of 10 % CV | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) | Subanalysis from 3 prospective trials (Basel, Paris, and Toulouse) evaluating patients with a history of CAD | |
| >9.3 pmol/l | 98 % (95-99 %) | ||||
| >9.8 pmol/l | 98 % (95-99 %) | ||||
| >14.1 pmol/l | 97 % (94-98 %) | ||||
| >18.9 pmol/l | 97 % (94-98 %) (all for NSTEMI) | ||||
| Charpentier et al. [12•] | ED population (single center). NSTEMI 14.8 % (95/641) | cTnI ADVIA Centaur (Siemens Diagnostics) >0.1 μg/l | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) | cTnI alone 92.8 % (90.8-94.8 %). | Subanalysis of a single-center prospective study. STEMI excluded |
| Combination: | |||||
| <12 pmol/l | 97.6 % (96.4-98.7 %) | ||||
| <14 pmol/l | 97.1 % (95.7-98.4 %) | ||||
| Charpentier [13•] | ED population (single center), NSTEMI 14.8 % (87/587). Fewer patients than in [12•] owing to insufficient blood samples | Sensitive TnI-Ultra ADVIA Centaur (Siemens Healthcare) cutoff 0.05 μg/l | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) <12 pmol/l | Sensitive TnI-Ultra alone 94.9 % (92.6-96.6 %), sensitive TnI plus copeptin 99.1 % (97.4-99.8 %). 46.8 % of patients with low TIMI score, NPV 100 % (97.7-100 %) for biomarker combination | Subanalysis of a single-center prospective serum-bank study (same study as Charpentier et al. [12•]). STEMI excluded |
| Llorens et al. [14•] | ED population (multicenter, 28 sites) with probable ACS. NSTEMI 10.5 % (107/1,018) | Respective troponin of daily practice (23 EDs TnT) (0.03 ng/ml), 2 EDs hsTnT (0.013 ng/ml), 3 EDs TnI (0.04 ng/ml) | Copeptin KRYPTOR (Thermo Fisher B·R·A·H·M·S) | Copeptin only in troponin-negative patients: | Multipurpose study. COPED substudy: STEMI patients, patients who tested positive for troponin at admission, and patients with noncoronary chest pain excluded |
|
5 pmol/l 10 pmol/l 14 pmol/l 18 pmol/l |
95 % 94.8 % 94.2 % 93.7 % |
||||
| Collinson et al. [15•] | ED population (multicenter study, 6 sites). NSTEMI 8.0 % (68/850) | Different TnT and TnI assays | Assay not reported. Cutoff 7.4 mg/l (not comparable with KRYPTOR results) | cTnI alone 98 % (0.97-0.99), cTnI plus copeptin 0.99 (0.97-1.0), cTnT alone 98 % (0.97-0.99), cTnT plus copeptin 98 % (0.97-0.99) | Subanalysis of the RATPAC study comparing troponin POCT with conventional management. High-risk patients and STEMI patients excluded |
ACS acute coronary syndrome, CAD coronary artery disease, CV coefficient of variation, cTnI cardiac troponin I, cTnT cardiac troponin T, hsTnT high-sensitivity troponin T, POCT point-of-care testing, STEMI ST-segment-elevation myocardial infarction TIMI thrombosis in myocardial infarction
aNPV for marker combination if not indicated otherwise.