title: Copeptin improves early diagnosis of acute myocardial infarction.
abstract: 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.
authors.affiliation: Department of Medicine II, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.forename: Stergios
authors.initials: S
authors.lastname: Tzikas
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.forename: Ewa
authors.initials: E
authors.lastname: Czyz
authors.forename: Lars
authors.initials: L
authors.lastname: Lillpopp
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Ojeda
authors.forename: Alexander
authors.initials: A
authors.lastname: Roth
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Sinning
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Dirk
authors.initials: D
authors.lastname: Peetz
authors.forename: Jan
authors.initials: J
authors.lastname: Kunde
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Felix
authors.initials: F
authors.lastname: Post
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.forename: Sabine
authors.initials: S
authors.lastname: Genth-Zotz
authors.forename: Viviane
authors.initials: V
authors.lastname: Nicaud
authors.forename: Laurence
authors.initials: L
authors.lastname: Tiret
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Münzel
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: 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
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; C048197:copeptins