Evidence map›Paper›PMID 31209082›Full record

ArticleBMJ open2019

Is high-sensitivity troponin, alone or in combination with copeptin, sensitive enough for ruling out NSTEMI in very early presenters at admission? A post hoc analysis performed in emergency departments.

Camille Chenevier-Gobeaux, Mustapha Sebbane, Christophe Meune, Sophie Lefebvre, Anne-Marie Dupuy, Guillaume Lefèvre, Nicolas Peschanski, Patrick Ray

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Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Camille Chenevier-GobeauxService de Diagnostic Biologique Automatisé, Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
Mustapha SebbaneDépartement des Urgences, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France.
Christophe MeuneService de Cardiologie, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint Denis, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny; Université Paris, Paris, France.
Sophie LefebvreDépartement des Urgences, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France.
Anne-Marie DupuyDépartement de Biochimie, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.
Guillaume LefèvreLaboratoire de Biochimie et Hormonologie, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
Nicolas PeschanskiUrgences-SMUR, Centre Hospitalier Eure-Seine - Hôpital d'Evreux, Rue Léon Schwartzenberg, Évreux, France.
Patrick RayCentre Régional Universitaire des Urgences, Hôpital François Mitterrand, 5 Boulevard Jeanne d'Arc, Dijon, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesCopeptin and high-sensitivity cardiac troponin (HS-cTn) assays improve the early detection of non-ST-segment elevation myocardial infarction (NSTEMI). Their sensitivities may, however, be reduced in very early presenters.

settingWe performed a post hoc analysis of three prospective studies that included patients who presented to the emergency department for chest pain onset (CPO) of less than 6 hours.

participants449 patients were included, in whom 12% had NSTEMI. CPO occurred <2 hours from ED presentation in 160, between 2 and 4 hours in 143 and >4 hours in 146 patients. The prevalence of NSTEMI was similar in all groups (9%, 13% and 12%, respectively, p=0.281). MEASURES: Diagnostic performances of HS-cTn and copeptin at presentation were examined according to CPO. The discharge diagnosis was adjudicated by two experts, including cardiac troponin I (cTnI). HS-cTn and copeptin were blindly measured.

resultsDiagnostic accuracies of cTnI, cTnI +copeptin and HS-cardiac troponin T (HS-cTnT) (but not HS-cTnT +copeptin) lower through CPO categories. For patients with CPO <2 hours, the choice of a threshold value of 14 ng/L for HS-cTnT resulted in three false negative (Sensitivity 80%(95% CI 51% to 95%); specificity 85% (95% CI 78% to 90%); 79% of correctly ruled out patients) and that of 5 ng/L in two false negative (sensitivity 87% (95% CI 59% to 98%); specificity 58% (95% CI 50% to 66%); 52% of correctly ruled out patients). The addition of copeptin to HS-cTnT induced a decrease of misclassified patients to 1 in patients with CPO <2 hours (sensitivity 93% (95% CI 66% to 100%); specificity 41% (95% CI 33% to 50%)).

conclusionA single measurement of HS-cTn, alone or in combination with copeptin at admission, seems not safe enough for ruling out NSTEMI in very early presenters (with CPO <2 hours). TRIAL REGISTRATION NUMBER: DC-2009-1052.

Indexed as

AdultAgedBiomarkersChest PainEmergency Service, HospitalFemaleGlycopeptidesHumansMaleMiddle AgedNon-ST Elevated Myocardial InfarctionPredictive Value of TestsProspective StudiesTime FactorsTroponin IBiomarkerscopeptinsGlycopeptidesTroponin Ichest painchest pain onsetcopeptinhigh sensitive cardiac troponinnon st-elevation acute myocardial infarctionvery early presenters

Identifiers

PMID31209082
PMCPMC6589015

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.