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Évaluation de la copeptine dans les syndromes coronaires aigus non ST+

Evaluation for copeptin in NSTEMIs

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Introduction

Une méthode fiable et rapide d’exclusion de l’infarctus du myocarde (IDM) représente un objectif médical crucial à atteindre. Une des pistes de la recherche actuelle est d’associer des marqueurs indépendants de la physiopathologie ischémique pour améliorer le diagnostic d’IDM.

Matériel et méthodes

Notre étude, observationnelle, rétrospective et monocentrique, a été réalisée sur une population de patients se présentant au service d’accueil des urgences du centre hospitalier Lyon-Sud pour une douleur thoracique apparue dans les six heures précédentes. Quatre-vingt-trois patients ont été inclus d’âge moyen de 64 ans dont neuf cas d’infarctus non ST+. Son objectif principal a été de déterminer la performance statistique de la copeptine dans l’exclusion des syndromes coronariens sans élévation du segment ST (SCA NST+). L’objectif secondaire a été d’estimer le gain de temps potentiel d’un schéma décisionnel utilisant le couple copeptine-première troponine par rapport au schéma classique double dosage de la troponine dans l’exclusion de l’IDM.

Résultats

Notre évaluation d’une stratégie double, associant copeptine et le premier dosage de troponine avec un cut-off de 9 pmol/l, retrouve un rapport de vraisemblance négatif proche de 0,0 (0,01–1,92), une sensibilité à 1,0 (IC 95 %: 0,66–1), une valeur prédictive négative à 1,0 (IC 95 %: 0,88–1) et un taux d’erreurs semblant être inférieur à 10 %. Le gain de temps potentiel en utilisant une stratégie double est de 310 minutes, soit un peu plus de cinq heures.

Conclusion

L’association de la copeptine améliore significativement la valeur diagnostique de la troponine pour l’exclusion des SCA NST+ aux urgences, tout en permettant au clinicien de réduire les délais de prise en charge.

Abstract

Introduction

A reliable and rapid method to exclude acute myocardial infarction (AMI) is a crucial medical objective to achieve. One area of current research is to use pathophysiological markers of independent dimensions to improve the diagnosis of AMI.

Material and methods

Our study, observational, retrospective and single-centered, was performed on a population of patients consulting to the Emergency Ward of the University Hospital of Lyon Sud for a chest pain that occurred within 6 hours. Its main objective was to determine the statistical performance of copeptin in non-ST elevated myocardial infarction (NSTEMI)-exclusion. Eighty-three patients were included with a mean age of 64 and with 9 patients diagnosed with NSTEMI. The secondary objective was to estimate the potential time savings of a decision tree using copeptin associated with the first troponin compared with the conventional double-troponin in the exclusion of MI.

Results

Our evaluation of a dual strategy, combining copeptin and the first troponin with a cutoff of 9 pmol/l, found a negative likelihood ratio close to 0.0 (0.01–1.92), a sensitivity close to 1.0 (95% CI: 0.66–1), a negative predictive value close to 1.0 (95%: 0.88–1) with an error rate of less than 10%. The time-saving potential of the decision tree using a dual strategy is estimated to be 310 min, or just over 5 hours.

Conclusion

The combination of troponin and copeptin significantly improves the diagnostic value of troponin for the exclusion of NSTEMI, while allowing the clinician to reduce delays in care.

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Authors and Affiliations

  1. Pôle des urgences, service d’accueil des urgences et service d’anesthésie-réanimation, chemin du Grand-Revoyet, Hospices civils de Lyon, Centre hospitalo-universitaire Lyon Sud, Pierre-Bénite, F-69394, Lyon cedex 03, France

    S. Ledochowski

  2. Pôle des urgences, service d’accueil des urgences, chemin du Grand-Revoyet, Hospices civils de Lyon, Centre hospitalo-universitaire Lyon Sud, Pierre-Bénite, F-69394, Lyon cedex 03, France

    J.-M. Fayet

  3. Pôle de biologie et d’anatomie pathologique, service de biochimie et biologie moléculaire Sud, chemin du Grand-Revoyet, Hospices civils de Lyon, Centre hospitalo-universitaire Lyon Sud, Pierre-Bénite, F-69394, Lyon cedex 03, France

    D. Collin-Chavagnac

  4. Centre d’investigation clinique, hôpital cardiovasculaire et pneumologique, Hospices civils de Lyon, UMR 5558, Université Lyon-I, F-69394, Lyon cedex 03, France

    E. Bonnefoy-Cudraz

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  1. S. Ledochowski
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  2. J.-M. Fayet
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  3. D. Collin-Chavagnac
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  4. E. Bonnefoy-Cudraz
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Correspondence to S. Ledochowski.

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Ledochowski, S., Fayet, JM., Collin-Chavagnac, D. et al. Évaluation de la copeptine dans les syndromes coronaires aigus non ST+. Ann. Fr. Med. Urgence 3, 138–144 (2013). https://doi.org/10.1007/s13341-013-0303-4

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  • DOI: https://doi.org/10.1007/s13341-013-0303-4

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