Table 4.
Diagnostic performances for NSTEMI according to CPO
| CPO | Biomarker | Threshold | Sensitivity (%, (95% CI)) |
Specificity (%, (95% CI)) |
Negative predictive value (%, (95% CI)) | Positive predictive value (%, (95% CI)) | Misdiagnosed (*) (n) | Correctly ruled out, n (%) |
| <2 hours (very early presenters) (n=160) |
cTnI cTnI+copeptin HS-cTnT HS-cTnT+copeptin |
LoQ† LoQ† and 12 pmol/L 14 ng/L 5 ng/L 3 ng/L 14 ng/L and 12 pmol/L 5 ng/L and 12 pmol/L 3 ng/L and 12 pmol/L |
73 (45 to 91) 87 (59 to 98) 80 (51 to 95) 87 (59 to 98) 87 (58 to 98) 93 (66 to 100) 93 (66 to 100) 93 [66 to 100] |
97 (92 to 99) 60 (52 to 68)‡ 85 (78 to 90)‡ 58 (50 to 66)‡§ 40 (32 to 49)‡§ 54 (46 to 62)‡§ 41 (33 to 50)‡§ 25 (19 to 34)‡§ |
97 (92 to 99) 98 (92 to 100) 98 (93 to 100) 98 (92 to 100) 97 (88 to 99) 99 (93 to 100) 98 (89 to 100) 97 (85 to 100) |
73 (45 to 91) 18 (7 to 24)‡ 35 (20 to 53) 18 (10 to 29)‡ 13 (7 to 22)‡ 18 (10 to 29)‡ 14 (8 to 23)‡ 12 (7 to 19)‡ |
4 2 3 2 2 1 1 1 |
141 (88) 87 (54)‡ 123 (79)‡ 84 (52)‡§ 58 (36)‡§ 79 (49)‡§ 59 (37)‡§ 37 (23)‡§ |
| 2–4 hours (n=143) |
cTnI cTnI+copeptin HS-cTnT HS-cTnT+copeptin |
LoQ† LoQ† and 12 pmol/L 14 ng/L 5 ng/L 3 ng/L 14 ng/L and 12 pmol/L 5 ng/L and 12 pmol/L 3 ng/L and 12 pmol/L |
73 (50 to 89) 95 (75 to 100) 77 (54 to 91) 91 (70 to 98) 96 (75 to 100) 95 (75 to 100) 100 (82 to 100) 100 (82 to 100) |
95 (89 to 98) 57 (48 to 66)‡ 79 (71 to 86)‡ 55 (46 to 64)‡§ 45 (36 to 54)‡§ 50 (41 to 59)‡§ 35 (27 to 44)‡§ 29 (21 to 38)‡§ |
95 (89 to 98)¶ 99 (92 to 100) 95 (88 to 98)¶ 97 (89 to 100) 98 (89 to 100) 99 (91 to 100) 100 (90 to 100) 100 (88 to 100) |
73 (50 to 89) 29 (19 to 41)‡ 40 (26 to 56) 27 (18 to 39)‡ 24 (16 to 34)‡ 25 (17 to 36)‡ 22 (15 to 32)‡ 20 (14 to 30)‡ |
6 1 5 2 1 1 0 0 |
115 (80) 69 (48)‡ 96 (67)‡** 67 (47)‡§ 54 (38)‡§ 58 (41)‡§ 42 (29)‡§ 35 (25)‡§ |
| >4 hours (n=146) |
cTnI cTnI+copeptin HScTnT HS-cTnT+copeptin |
LoQ† LoQ † and 12 pmol/L 14 ng/L 5 ng/L 3 ng/L 14 ng/L and 12 pmol/L 5 ng/L and 12 pmol/L 3 ng/L and 12 pmol/L |
100 (77 to 100) 100 (77 to 100) 100 (78 to 100) 100 (78 to 100) 100 (78 to 100) 100 (78 to 100) 100 (78 to 100) 100 (78 to 100) |
96 (91 to 99) 59 (50 to 68)‡ 87 (80 to 92)‡ 60 (51 to 68)‡§ 52 (43 to 61)‡§ 55 (46 to 64)‡§ 40 (32 to 49)‡§ 34 (26 to 43)‡§ |
100 (96 to 100) 100 (94 to 100) 100 (96 to 100) 100 (94 to 100) 100 (96 to 100) 100 (94 to 100) 100 (91 to 100) 100 (96 to 100) |
77 (54 to 91) 25 (16 to 37)‡ 51 (34 to 68) 35 (23 to 50)‡ 23 (14 to 34)‡ 24 (15 to 35)‡ 19 (12 to 29)‡ § 18 (11 to 27)‡ § |
0 0 0 0 0 0 0 0 |
122 (85) 75 (54)‡ 111 (77) 77 (53)‡§** 67 (47)‡§ 70 (49)‡§ 51 (35)‡§ 43 (30)‡§ |
*False negative patients.
†0.04 µg/L (40 ng/L) for Bicêtre and Montpellier hospitals, 0.14 µg/L (140 ng/L) for other sites.
‡P<0.05 versus cTnI alone.
§P<0.05 versus HS-cTnT <14 ng/L alone.
¶P<0.05 versus delay >4 hours.
**P<0.05 versus delay <2 hours.
CPO, chest pain onset; cTnI, cardiac troponin I; HS-cTnT, high-sensitivity cardiac troponin T; LoQ, limit of quantitation; NSTEMI, non-ST-segment elevation myocardial infarction.