title: Copeptin for rapid rule out of acute myocardial infarction in emergency department.
abstract: BACKGROUND
  Copeptin, in combination with conventional troponin (cTn), has been suggested as a means of rapid rule out of the diagnosis of acute myocardial infarction (AMI). This study aims to assess the value of copeptin for rule out of AMI, according to the pre-test probability (PTP).
  
  
  METHODS
  In a prospective multicentric study, we enrolled patients presenting into emergency departments with chest pain <6h, copeptin was measured, and PTP was quoted. The discharge diagnosis was adjudicated by 2 independent experts using all available data, including cTnI.
  
  
  RESULTS
  317 patients were included: 148 (46%) had low, 110 (35%) moderate and 59 (19%) high PTP. Final diagnosis was AMI in 45 patients (14%). Median copeptin level was higher in AMI patients compared with that in patients having other diagnoses (23.2 vs. 9.9 pmol/L, p=0.01). A copeptin level ≥10.7 pmol/L in combination with cTnI detected AMI with higher sensitivity than for cTnI alone (98 [87-100] vs. 71 [55-83] %, p=0.001), whatever the PTP. The negative predictive value of the combination copeptin+cTnI was increased, compared to that of cTnI alone (99 [97-100] vs. 95 [92-97] %, p<0.05).
  
  
  CONCLUSIONS
  In triage of chest pain patients, the additional use of copeptin with conventional cTnI might allow a rapid and reliable rule out of the diagnosis of AMI regardless of the PTP.
authors: Department of Biochemistry, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France. camille.gobeaux@cch.aphp.fr
authors: Camille
authors: C
authors: Chenevier-Gobeaux
authors: Yonathan
authors: Y
authors: Freund
authors: Yann-Erick
authors: YE
authors: Claessens
authors: Sylvie
authors: S
authors: Guérin
authors: Pascale
authors: P
authors: Bonnet
authors: Benoit
authors: B
authors: Doumenc
authors: François
authors: F
authors: Leumani
authors: Claudine
authors: C
authors: Cosson
authors: Jean-Christophe
authors: JC
authors: Allo
authors: Bruno
authors: B
authors: Riou
authors: Patrick
authors: P
authors: Ray
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006020:Glycopeptides; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D011446:Prospective Studies; D011498:Protein Precursors; D013997:Time Factors; D014218:Triage / Q000379:methods / Q000592:standards; D014336:Troponin
chemical_list: D006020:Glycopeptides; D011498:Protein Precursors; D014336:Troponin; C048197:copeptins