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Date of Award
Spring 2020
Degree Name
Other
Master of Public Health and Master of Medical Science (Physician Assistant)
Department
Other
Community & Global Health, Physician Assistant; College of Health Sciences
First Advisor
Shannon Diallo
Second Advisor
Kimberly Erikson
Third Advisor
Amanda Seymour
Abstract
Abstract
Introduction: Atherosclerosis is the build-up of plaque in the arteries. When these plaques become unstable they can rupture and cause acute coronary syndrome (ACS). ACS is an imbalance between cardiac oxygen supply and demand generally due to a coronary artery obstruction causing acute myocardial ischemia (AMI). AMI is an operational term that can refer to: unstable angina, ST-segment myocardial infarction, and non-ST segment elevation myocardial infarction. The results of an electrocardiograph and cardiac biomarkers present in the blood help to differential these terms thus providing a diagnosis. Seventy percent of patients presenting with ACS will have an NSTEMI and then require serial cardiac troponin values to ensure accurate diagnosis between unstable angina and NSTEMI. This paper will investigate the efficacy of combination testing of the copeptin biomarker with cardiac troponin in risk stratification of ACS patients and the potential benefits of making this standard of care.
Methods: A literature search was conducted through EBSCOhost and PubMed on November of 2018. A total of seven articles consisting of one randomized control trials and six prospective studies were selected based on English language, publication date, relevance to the research question, and study techniques.
Results: Based on the literature review, there is positive evidence that combination testing is noninferior to serial cardiac troponin blood draws in ruling out NSTEMI. One study found combined testing appears safe in early discharge of low to intermediate risk patients and shortens hospital length of stay. Another study found that the combined testing improves sensitivity and negative likelihood ratio for NSTEMI than serial cardiac troponin alone.
Discussion: All but two studies found that combination testing at presentation was noninferior to the standard of care of serial troponin blood draws in ruling out NSTEMI-ACS. The two studies that did not find copeptin a statistically significant biomarker utilized an outdated assay with lower sensitivity than did the other five studies that found copeptin to be a statistically significant biomarker. There were various limitations in each study.
Conclusion: Combination testing of copeptin with cardiac troponin should be considered as an addition to the standard of care for ACS patients presenting to the emergency department. Further studies should focus on randomized control trials, follow-up, and cost-benefits analysis in hospitals.
Recommended Citation
DeJaeghere, Elizabeth, "In ACS patients presenting to the ED, does an initial combined blood draw of copeptin and cardiac troponin lead to improved patient and hospital outcomes when compared to serial cardiac troponin blood draws alone?" (2020). Capstone Showcase. 95.
https://scholarworks.arcadia.edu/showcase/2020/pa/95
In ACS patients presenting to the ED, does an initial combined blood draw of copeptin and cardiac troponin lead to improved patient and hospital outcomes when compared to serial cardiac troponin blood draws alone?
Abstract
Introduction: Atherosclerosis is the build-up of plaque in the arteries. When these plaques become unstable they can rupture and cause acute coronary syndrome (ACS). ACS is an imbalance between cardiac oxygen supply and demand generally due to a coronary artery obstruction causing acute myocardial ischemia (AMI). AMI is an operational term that can refer to: unstable angina, ST-segment myocardial infarction, and non-ST segment elevation myocardial infarction. The results of an electrocardiograph and cardiac biomarkers present in the blood help to differential these terms thus providing a diagnosis. Seventy percent of patients presenting with ACS will have an NSTEMI and then require serial cardiac troponin values to ensure accurate diagnosis between unstable angina and NSTEMI. This paper will investigate the efficacy of combination testing of the copeptin biomarker with cardiac troponin in risk stratification of ACS patients and the potential benefits of making this standard of care.
Methods: A literature search was conducted through EBSCOhost and PubMed on November of 2018. A total of seven articles consisting of one randomized control trials and six prospective studies were selected based on English language, publication date, relevance to the research question, and study techniques.
Results: Based on the literature review, there is positive evidence that combination testing is noninferior to serial cardiac troponin blood draws in ruling out NSTEMI. One study found combined testing appears safe in early discharge of low to intermediate risk patients and shortens hospital length of stay. Another study found that the combined testing improves sensitivity and negative likelihood ratio for NSTEMI than serial cardiac troponin alone.
Discussion: All but two studies found that combination testing at presentation was noninferior to the standard of care of serial troponin blood draws in ruling out NSTEMI-ACS. The two studies that did not find copeptin a statistically significant biomarker utilized an outdated assay with lower sensitivity than did the other five studies that found copeptin to be a statistically significant biomarker. There were various limitations in each study.
Conclusion: Combination testing of copeptin with cardiac troponin should be considered as an addition to the standard of care for ACS patients presenting to the emergency department. Further studies should focus on randomized control trials, follow-up, and cost-benefits analysis in hospitals.