title: Incremental value of copeptin for rapid rule out of acute myocardial infarction.
abstract: OBJECTIVE
  The purpose of this study was to examine the incremental value of copeptin for rapid rule out of acute myocardial infarction (AMI).
  
  
  BACKGROUND
  The rapid and reliable exclusion of AMI is a major unmet clinical need. Copeptin, the C-terminal part of the vasopressin prohormone, as a marker of acute endogenous stress may be useful in this setting.
  
  
  METHODS
  In 487 consecutive patients presenting to the emergency department with symptoms suggestive of AMI, we measured levels of copeptin at presentation, using a novel sandwich immunoluminometric assay in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists using all available data.
  
  
  RESULTS
  The adjudicated final diagnosis was AMI in 81 patients (17%). Copeptin levels were significantly higher in AMI patients compared with those in patients having other diagnoses (median 20.8 pmol/l vs. 6.0 pmol/l, p < 0.001). The combination of troponin T and copeptin at initial presentation resulted in an area under the receiver-operating characteristic curve of 0.97 (95% confidence interval: 0.95 to 0.98), which was significantly higher than the 0.86 (95% confidence interval: 0.80 to 0.92) for troponin T alone (p < 0.001). A copeptin level <14 pmol/l in combination with a troponin T < or =0.01 microg/l correctly ruled out AMI with a sensitivity of 98.8% and a negative predictive value of 99.7%.
  
  
  CONCLUSIONS
  The additional use of copeptin seems to allow a rapid and reliable rule out of AMI already at presentation and may thereby obviate the need for prolonged monitoring and serial blood sampling in the majority of patients. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587).
authors: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors: Tobias
authors: T
authors: Reichlin
authors: Willibald
authors: W
authors: Hochholzer
authors: Claudia
authors: C
authors: Stelzig
authors: Kirsten
authors: K
authors: Laule
authors: Heike
authors: H
authors: Freidank
authors: Nils G
authors: NG
authors: Morgenthaler
authors: Andreas
authors: A
authors: Bergmann
authors: Mihael
authors: M
authors: Potocki
authors: Markus
authors: M
authors: Noveanu
authors: Tobias
authors: T
authors: Breidthardt
authors: Andreas
authors: A
authors: Christ
authors: Tujana
authors: T
authors: Boldanova
authors: Ramona
authors: R
authors: Merki
authors: Nora
authors: N
authors: Schaub
authors: Roland
authors: R
authors: Bingisser
authors: Michael
authors: M
authors: Christ
authors: Christian
authors: C
authors: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins