title: Prevalence, characteristics and outcome of non-cardiac chest pain and elevated copeptin levels.
abstract: OBJECTIVE
  Copeptin, a quantitative marker of endogenous stress, seems to provide incremental value in addition to cardiac troponin in the early rule-out of acute myocardial infarction (AMI). Prevalence, characteristics and outcome of acute chest pain patients with causes other than AMI and elevated copeptin are poorly understood.
  
  
  METHODS
  A total of 984 consecutive patients with non-cardiac chest pain were selected from a prospective multicentre study of acute chest pain patients presenting to the emergency department. Levels of copeptin were determined in a blinded fashion and considered elevated if above 13 pmol/L (the 97,5th centile of healthy individuals). The final diagnosis was adjudicated by two independent cardiologists. Median duration of follow-up was 756 days.
  
  
  RESULTS
  Elevated copeptin levels were seen in 215 patients (22%). In comparison to patients with normal copeptin levels, patients with elevated levels were older, had more pre-existing cardiac and non-cardiac disorders, more silent cardiomyocyte injury and increased haemodynamic stress as quantified by levels of high-sensitivity cardiac troponin T (9.6 ng/L (3.6-18.3) vs 5.8 ng/L (2.9-9.4)) and B-type natriuretic peptide (75 ng/L (37-187) vs 35 ng/L (15-77)) (both p<0.001), more electrocardiographic abnormalities, more often an adjudicated diagnosis of gastroesophageal reflux or bronchitis/pneumonia and higher 2- year mortality (HR 2.9, 95% CI 1.5  to 5.7). The increased mortality rate seemed to be largely explained by age and comorbidities.
  
  
  CONCLUSIONS
  Elevated levels of copeptin are present in about one in five patients with non-cardiac chest pain and are associated with aging, cardiac and non-cardiac comorbidities as well as mortality.
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Fabio
authors: F
authors: Stallone
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors: Raphael
authors: R
authors: Twerenbold
authors: Department of Cardiology, University Hospital Basel, Basel, Switzerland Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors: Karin
authors: K
authors: Wildi
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Tobias
authors: T
authors: Reichlin
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors: Maria
authors: M
authors: Rubini Gimenez
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Philip
authors: P
authors: Haaf
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors: Nicole
authors: N
authors: Fuechslin
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Petra
authors: P
authors: Hillinger
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Cedric
authors: C
authors: Jaeger
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Philipp
authors: P
authors: Kreutzinger
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Christian
authors: C
authors: Puelacher
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Milos
authors: M
authors: Radosavac
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Zoraida
authors: Z
authors: Moreno Weidmann
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors: Berit
authors: B
authors: Moehring
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Ursina
authors: U
authors: Honegger
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Carmela
authors: C
authors: Schumacher
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors: Kris
authors: K
authors: Denhaerynck
authors: Medizinische Klinik, Kantonsspital Olten, Basel, Switzerland.
authors: Christiane
authors: C
authors: Arnold
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Emergency department, University Hospital, Basel, Switzerland.
authors: Roland
authors: R
authors: Bingisser
authors: BRAHMS GmbH, Thermo Fisher Scientific, Henningsdorf, Germany.
authors: Jörn Ole
authors: JO
authors: Vollert
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Stefan
authors: S
authors: Osswald
authors: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Christian
authors: C
authors: Mueller
mesh_terms: D059787:Acute Pain / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006020:Glycopeptides / Q000097:blood*; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011498:Protein Precursors; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; D020107:Troponin T; C048197:copeptins; D020097:Natriuretic Peptide, Brain
keywords: CORONARY ARTERY DISEASE