{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:10:10Z","timestamp":1778130610342,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Copeptin, a marker of endogenous stress, has been used for the early detection of non-ST elevation myocardial infarction (NSTEMI) in combination with conventional cardiac troponin. However, its incremental diagnostic value, when combined with high-sensitivity troponin, is not well defined. This study seeks to assess the diagnostic performance for NSTEMI of a Dual Marker Strategy (DMS) [copeptin and high-sensitivity cardiac troponin T (hs-cTnT)] measured upon presentation to the Emergency Department (ED) and compare it to the hs-cTnT 0h\/1h and 0h\/2h algorithms recommended by the European Society of Cardiology (ESC). Methods: This prospective observational study enrolled 102 patients presenting to the ED with chest pain of &lt;6 h duration; patients with ST elevation myocardial infarction (STEMI) were excluded. Copeptin and hs-cTnT were measured upon patient presentation (time 0 h, DMS) in the whole cohort. hs-cTnT was subsequently repeated either at 1 h (n = 51) or 2 h (n = 51). The diagnostic performance of the DMS, assessed in terms of sensitivity, specificity, and negative (NPV) and positive predictive value (PPV), was compared to that of the ESC-recommended hs-cTnT algorithms 0h\/1h and 0h\/2h for NSTEMI. Results: Of the total population, 59.8% were men, with a mean age of 57.7 \u00b1 18.4 years; 8.8% of the patients were eventually di agnosed with NSTEMI. The DMS (cut-offs: copeptin &lt; 10 pmol\/L and hs-cTnT &lt; 14 ng\/L) demonstrated a sensitivity of 88.9% (95% CI: 51.75\u201399.72) and an NPV of 98.5% (90.94\u201399.76). On the other hand, the hs-cTnT 0h\/1h algorithm showed a sensitivity of 60% (14.66\u201394.73) and an NPV of 95.6% (88.06\u201398.45), while the hs-cTnT 0h\/2h algorithm exhibited a sensitivity of 75% (19.41\u201399.37) and an NPV of 95.8% (85.22\u201398.93). In ROC analysis, copeptin yielded an AUC of 0.702 (p = 0.046) and hs-cTnT at 0h showed an AUC of 0.736 (p = 0.02), whereas their combination demonstrated an AUC of 0.730 (p = 0.023) for the detection of NSTEMI. Conclusions: The copeptin\/hs-cTnT DMS has comparable diagnostic performance to the hs-cTnT 0h\/1h and 0h\/2h algorithms for the early rule-out of NSTEMI.<\/jats:p>","DOI":"10.3390\/jcm15093251","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:28:23Z","timestamp":1777040903000},"page":"3251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Incremental Value of Copeptin for the Early Rule-Out of Non-ST Elevation Myocardial Infarction in the Emergency Department"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2038-844X","authenticated-orcid":false,"given":"Sofia","family":"Bezati","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3041-4787","authenticated-orcid":false,"given":"Christos","family":"Verras","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-5443","authenticated-orcid":false,"given":"Vasiliki","family":"Bistola","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-0346","authenticated-orcid":false,"given":"Dionysis","family":"Matsiras","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-7511","authenticated-orcid":false,"given":"Estela","family":"Kiouri","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lambros","family":"Markos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7572-4527","authenticated-orcid":false,"given":"Ioannis","family":"Ventoulis","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7585-1203","authenticated-orcid":false,"given":"Effie","family":"Polyzogopoulou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Parissis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","unstructured":"(2026, March 30). 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