Copeptin improves early diagnosis of acute myocardial infarction.

Abstract

OBJECTIVES:

Early identification of myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation.

BACKGROUND:

The aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to cardiac troponin in early evaluation of patients with suspected myocardial infarction.

METHODS:

Between January 2007 and July 2008, patients with suspected acute coronary syndrome were consecutively enrolled in this multicenter study. Copeptin, troponin T (TnT), myoglobin, and creatine kinase-myocardial band were determined at admission and after 3 and 6 h.

RESULTS:

Of 1,386 (66.4% male) enrolled patients, 299 (21.6%) had the discharge diagnosis of acute myocardial infarction, 184 (13.3%) presented with unstable angina, and in 903 (65.2%) an acute coronary syndrome could be excluded. Combined measurement of copeptin and TnT on admission improved the c-statistic from 0.84 for TnT alone to 0.93 in the overall population and from 0.77 to 0.9 in patients presenting within 3 h after chest pain onset (CPO) (p < 0.001). In this group the combination of copeptin with a conventional TnT provided a negative predictive value of 92.4%.

CONCLUSIONS:

In triage of chest pain patients, determination of copeptin in addition to troponin improves diagnostic performance, especially early after CPO. Combined determination of troponin and copeptin provides a remarkable negative predictive value virtually independent of CPO time and therefore aids in early and safe rule-out of myocardial infarction.

• Authors: Till Keller, Stergios Tzikas, Tanja Zeller, Ewa Czyz, Lars Lillpopp, Francisco M Ojeda, Alexander Roth, Christoph Bickel, Stephan Baldus, Christoph R Sinning, Philipp S Wild, Edith Lubos, Dirk Peetz, Jan Kunde, Oliver Hartmann, Andreas Bergmann, Felix Post, Karl J Lackner, Sabine Genth-Zotz, Viviane Nicaud, Laurence Tiret, Thomas F Münzel, Stefan Blankenberg
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 55 Issue 19 Pg. 2096-106 (May 11 2010) ISSN: 1558-3597 [Electronic] United States
• PMID: 20447532 (Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Glycopeptides
• Myoglobin
• Troponin I
• Troponin T
• copeptins

Topics

• Adult
• Aged
• Angina Pectoris (blood, diagnosis, etiology)
• Biomarkers (blood)
• Early Diagnosis
• Female
• Glycopeptides (blood)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, complications, diagnosis)
• Myoglobin (blood)
• Predictive Value of Tests
• Prospective Studies
• Troponin I (blood)
• Troponin T (blood)