title: A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction.
abstract: Multiple studies have evaluated copeptin, a surrogate for arginine vasopressin, in the diagnosis of acute myocardial infarction (AMI) with mixed results. A systematic review and collaborative meta-analysis were performed for diagnosis of AMI and assessment of prognosis in patients presenting to the emergency department with chest pain. MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing copeptin in such patients. Study investigators were contacted, and many provided previously unpublished data. Random-effects methods were used to compare the data for copeptin, troponin, and their combination. There were a total of 9,244 patients from the 14 included studies. Mean age was 62 years; 64% were men; and 18.4% were ultimately diagnosed with AMI. Patients with AMI had a higher presentation copeptin level than those without AMI (22.8 vs 8.3 pmol/L, respectively, p <0.001). Although troponin had better diagnostic accuracy than copeptin for AMI, the combination of copeptin and troponin significantly improved the sensitivity (0.905 [0.888 to 0.921] vs 0.686 [0.661 to 0.710], respectively, p <0.001) and negative predictive value (0.97 [0.964 to 0.975] vs 0.93 [0.924 to 0.936], respectively, p <0.001) compared with troponin alone. Elevation in copeptin carried a similar risk of all-cause mortality to an elevation in troponin (odds ratio 5.84 vs 6.74, respectively, p = 0.67). In conclusion, copeptin not only identifies patients at risk of all-cause mortality, but its addition to troponin improved the sensitivity and negative likelihood ratio for diagnosis of AMI compared with troponin alone. Thus, copeptin may help identify patients who may be safely discharged early from the emergency department.
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhães
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Epstein
authors.affiliation: Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain; Research Group: "Emergencies: Processes and Pathologies", IDIBAPS, Barcelona, Catalonia, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Miró
authors.affiliation: Emergency Department, Short Stay Unit and Hospital at Home Care, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Frankenhausen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.affiliation: Départment des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lefebvre
authors.affiliation: Départment des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
authors.affiliation: Département de Biochimie, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
authors.affiliation: Clinical Chemistry Laboratory, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.affiliation: Cardiology Department, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France; Cardiology Department, Paris XIII University, Avicenne Hospital, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.affiliation: Emergency Department, University Hospital of Rangueil, Toulouse, France; Team5 INSERM 1027, Toulouse University, Toulouse, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Charpentier
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland; Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D015415:Biomarkers / Q000032:analysis; D005260:Female; D006020:Glycopeptides / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins