Rapid stratification value of the Dual-Marker Strategy (high sensitivity cardiac troponin T combined with Copeptin) in patients with suspected non-ST-segment elevation myocardial infarction in a real-world setting
10.3760/cma.j.cn114656-20250401-00247
- VernacularTitle:和肽素联合高敏肌钙蛋白的双标志物策略对疑似NSTEMI患者快速分流的真实世界价值研究
- Author:
Dongxu CHEN
1
;
Yao YU
;
Chen CHEN
;
Yulong LIU
;
Chaoyang TONG
;
Zhenju SONG
;
Guorong GU
;
Chenling YAO
Author Information
1. 复旦大学附属中山医院急诊科，上海 200032
- Keywords:
Copeptin;
High sensitivity cardiac troponin (Hs-cTn);
Non-ST-Segment Elevation Myocardial Infarction (NSTEMI);
Dual-Marker Strategy (DMS);
Diversion of pa
- From:
Chinese Journal of Emergency Medicine
2025;34(8):1091-1097
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the real-world triage performance of a dual-marker strategy (DMS) combining copeptin and high-sensitivity cardiac troponin T (hs-cTnT) in patients presenting with chest pain and suspected non-ST-segment elevation myocardial infarction (NSTEMI).Methods:It was conducted a prospective study of 277 consecutive chest pain patients admitted to the Emergency Department of Zhongshan Hospital, Fudan University, between July and August 2023. Admission levels of copeptin and hs-cTnT were measured. The safety, efficacy, and triage efficiency of the DMS (defined as copeptin <10 pmol/L and hs-cTnT <0.014 ng/mL) for excluding NSTEMI were evaluated based on final diagnoses and clinical outcomes.Results:Among 277 patients, 141 (50.9%) had cardiogenic diseases (51 NSTEMI, 37 unstable angina pectoris [UAP], 11 myocardial bridges, and 42 non-coronary artery disease), 29 (10.5%) had non-cardiac conditions, and 107 (38.6%) had low-risk chest pain of unknown etiology. A total of 103 patients (37.2%) were DMS-negative (copeptin and hs-cTnT both below cutoff), including 0 NSTEMI cases, 2 UAP cases, 1 myocardial bridge, 6 non-coronary artery diseases, 4 non-cardiac conditions, and 90 low-risk cases. The DMS demonstrated a negative predictive value (NPV) of 100% for excluding NSTEMI, with no major adverse cardiac events (MACE) observed in DMS-negative patients during 30-day follow-up. Real-world data revealed that only 42.2% of suspected NSTEMI patients received a second troponin test (timing: 1 hour—5.9%, 2 hours—23.9%, ≥3 hours—70.1%). The DMS enabled safe and efficient triage of 37.2% of chest pain patients at 0-hour, outperforming other strategies in applicability and feasibility ( P < 0.05). Conclusions:In real-world clinical practice, the DMS (copeptin combined with hs-cTnT) optimally complements guideline-recommended hs-cTnT algorithms. It provides a simple, rapid, and safe approach to managing acute chest pain, demonstrating superior applicability for improving emergency triage efficiency.
