title: Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction).
abstract: OBJECTIVE
  The goal of this study was to demonstrate that copeptin levels <14 pmol/L allow ruling out acute myocardial infarction (AMI) when used in combination with cardiac troponin I (cTnI) <99 th percentile and a nondiagnostic electrocardiogram at the time of presentation to the emergency department (ED).
  
  
  BACKGROUND
  Copeptin is secreted from the pituitary early in the course of AMI.
  
  
  METHODS
  This was a 16-site study in 1,967 patients with chest pain presenting to an ED within 6 hours of pain onset. Baseline demographic characteristics and clinical data were collected prospectively. Copeptin levels and a contemporary sensitive cTnI (99 th percentile 40 ng/l; 10% coefficient of variation 0.03 μg/l) were measured in a core laboratory. Patients were followed up for 180 days. The primary outcome was diagnosis of AMI. Final diagnoses were adjudicated by 2 independent cardiologists blinded to copeptin results.
  
  
  RESULTS
  AMI was the final diagnosis in 156 patients (7.9%). A negative copeptin and cTnI at baseline ruled out AMI for 58% of patients, with a negative predictive value of 99.2% (95% confidence interval: 98.5 to 99.6). AMIs not detected by the initial cTnI alone were picked up with copeptin >14 pmol/l in 23 (72%) of 32 patients. Non-ST-segment elevation myocardial infarctions undetected by cTnI at 0 h were detected with copeptin >14 pmol/l in 10 (53%) of 19 patients. Projected average time-to-decision could be reduced by 43% (from 3.0 h to 1.8 h) by the early rule out of 58% of patients. Both abnormal copeptin and cTnI were predictors of death at 180 days (p < 0.0001 for both; c index 0.784 and 0.800, respectively). Both were independent of age and each other and provided additional predictive value (all p < 0.0001).
  
  
  CONCLUSIONS
  Adding copeptin to cTnI allowed safe rule out of AMI with a negative predictive value >99% in patients presenting with suspected acute coronary syndromes. This combination has the potential to rule out AMI in 58% of patients without serial blood draws.
authors: VA San Diego Healthcare System, San Diego, California; University of California, San Diego, California. Electronic address: amaisel@ucsd.edu.
authors: Alan
authors: A
authors: Maisel
authors: University Hospital Basel, Basel, Switzerland.
authors: Christian
authors: C
authors: Mueller
authors: University of California, San Diego, California.
authors: Sean-Xavier
authors: SX
authors: Neath
authors: University of Maryland School of Medicine, Baltimore, Maryland.
authors: Robert H
authors: RH
authors: Christenson
authors: Charite, Campus Virchow-Klinikum, Berlin, Germany.
authors: Nils G
authors: NG
authors: Morgenthaler
authors: Henry Ford Health System, Detroit, Michigan.
authors: James
authors: J
authors: McCord
authors: Henry Ford Health System, Detroit, Michigan.
authors: Richard M
authors: RM
authors: Nowak
authors: University of California, San Diego, California.
authors: Gary
authors: G
authors: Vilke
authors: University of California, San Diego, California.
authors: Lori B
authors: LB
authors: Daniels
authors: University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Judd E
authors: JE
authors: Hollander
authors: Hennepin County Medical Center, Minneapolis, Minnesota.
authors: Fred S
authors: FS
authors: Apple
authors: University of Kansas Hospital, Kansas City, Kansas.
authors: Chad
authors: C
authors: Cannon
authors: Massachusetts General Hospital, Boston, Massachusetts.
authors: John T
authors: JT
authors: Nagurney
authors: Stanford University School of Medicine, Palo Alto, California.
authors: Donald
authors: D
authors: Schreiber
authors: University of Maryland School of Medicine, Baltimore, Maryland.
authors: Christopher
authors: C
authors: deFilippi
authors: Virginia Commonwealth University, Richmond, Virginia.
authors: Christopher
authors: C
authors: Hogan
authors: University of California, Davis Medical Center, Sacramento, California.
authors: Deborah B
authors: DB
authors: Diercks
authors: University of California, San Francisco, California.
authors: John C
authors: JC
authors: Stein
authors: Medical University of South Carolina, Charleston, South Carolina.
authors: Gary
authors: G
authors: Headden
authors: Duke University Medical Center, Durham, North Carolina.
authors: Alexander T
authors: AT
authors: Limkakeng
authors: VA Minneapolis, Minnesota.
authors: Inder
authors: I
authors: Anand
authors: University of California, San Francisco, California.
authors: Alan H B
authors: AHB
authors: Wu
authors: Thermo Scientific Biomarkers, Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf/Berlin, Germany.
authors: Jana
authors: J
authors: Papassotiriou
authors: Thermo Scientific Biomarkers, Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf/Berlin, Germany.
authors: Oliver
authors: O
authors: Hartmann
authors: Thermo Scientific Biomarkers, Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf/Berlin, Germany.
authors: Stefan
authors: S
authors: Ebmeyer
authors: VA San Diego Healthcare System, San Diego, California.
authors: Paul
authors: P
authors: Clopton
authors: Mayo Clinic, Rochester, Minnesota.
authors: Allan S
authors: AS
authors: Jaffe
authors: Baylor College of Medicine, Houston, Texas.
authors: W Frank
authors: WF
authors: Peacock
mesh_terms: D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D042241:Early Diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D019210:Troponin I; C048197:copeptins