title: Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
abstract: OBJECTIVE
  The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD).
  
  
  METHODS
  Patients with a previous history of CAD presenting in the emergency department with acute chest pain lasting for 6 hours or less suggestive of non-ST-segment elevation AMI and negative cTn were selected. Levels of copeptin were blindly measured at presentation. The diagnosis was adjudicated by 2 independent experts using all available data including cTn.
  
  
  RESULTS
  A total of 451 patients were included (mean age, 67±14; 330 [73%] men). The adjudicated final diagnosis was AMI in 36 (8%) patients, unstable angina in 131 (29%), and other diagnosis in 284 (63%). A negative cTn combined with a copeptin value lower than 10.7 pmol/L at presentation was able to rule out AMI, with a negative predictive value of 98% (95% confidence interval, 95%-99%).
  
  
  CONCLUSIONS
  In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
authors.affiliation: Department of Emergency Medicine, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM UMRS 956, Université Pierre et Marie Curie-Paris 6, 75013, Paris, France. patrick.ray@tnn.aphp.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.forename: Sandrine
authors.initials: S
authors.lastname: Charpentier
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Yann-Erick
authors.initials: YE
authors.lastname: Claessens
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology*; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D016037:Single-Blind Method; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D019210:Troponin I; C048197:copeptins