Copeptin improves early diagnosis of acute myocardial infarction.
OBJECTIVE
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.
Keller
Till
T
Department of Medicine II, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Tzikas
Stergios
S
Zeller
Tanja
T
Czyz
Ewa
E
Lillpopp
Lars
L
Ojeda
Francisco M
FM
Roth
Alexander
A
Bickel
Christoph
C
Baldus
Stephan
S
Sinning
Christoph R
CR
Wild
Philipp S
PS
Lubos
Edith
E
Peetz
Dirk
D
Kunde
Jan
J
Hartmann
Oliver
O
Bergmann
Andreas
A
Post
Felix
F
Lackner
Karl J
KJ
Genth-Zotz
Sabine
S
Nicaud
Viviane
V
Tiret
Laurence
L
Münzel
Thomas F
TF
Blankenberg
Stefan
S
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D006020:Glycopeptides; D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; C048197:copeptins