title: Copeptin does not add diagnostic information to high-sensitivity troponin T in low- to intermediate-risk patients with acute chest pain: results from the rule out myocardial infarction by computed tomography (ROMICAT) study.
abstract: OBJECTIVE
  Copeptin, a stable peptide derived from the AVP precursor, has been linked to presence and severity of myocardial ischemia. We sought to evaluate the predictive value of copeptin and its incremental value beyond that of high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute chest pain and low to intermediate risk for acute coronary syndrome (ACS).
  
  
  METHODS
  We recruited patients who presented with acute chest pain to the emergency department and had a negative initial conventional troponin T test (<0.03 μg/L). In all patients, hs-cTnT and copeptin measurements were taken. Each patient also underwent cardiac computed tomography (CT) and coronary angiography.
  
  
  RESULTS
  Baseline copeptin concentrations, in contrast to hs-cTnT, were not significantly higher in patients with ACS than in those without (P = 0.24). hs-cTnT showed an earlier rise in patients with ACS than copeptin, when analyses were stratified by time. A copeptin concentration ≥7.38 pmol/L had a negative predictive value (NPV) of 94% and a sensitivity of 51%, whereas hs-cTnT (≥13.0 pg/mL) had a NPV of 96% and a sensitivity of 63%. The combination of copeptin and hs-cTnT resulted in a lower diagnostic accuracy than hs-cTnT alone. Finally, on cardiac CT, copeptin concentrations were not associated with coronary artery morphology, although they were related to the presence of left ventricular dysfunction (P = 0.02).
  
  
  CONCLUSIONS
  Among patients with acute chest pain and low to intermediate risk for ACS, copeptin concentrations are not independently predictive of ACS and do not add diagnostic value beyond that of hs-cTnT measurements.
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Mahir
authors.initials: M
authors.lastname: Karakas
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Julia
authors.initials: J
authors.lastname: Meyer
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rottbauer
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Selcuk
authors.initials: S
authors.lastname: Dasdemir
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D001127:Arginine Vasopressin / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; D020107:Troponin T; C048197:copeptins; D001127:Arginine Vasopressin