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

{Objectives Copeptin 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. Setting We 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. Participants 449 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