title: Use of copeptin in emergency patients with cardiac chief complaints.
abstract: BACKGROUND
  Combined testing of copeptin and troponin at presentation to the emergency department (ED) has been shown to possess a high negative predictive value (NPV) for ruling out acute myocardial infarction (AMI) in patients with suspected acute coronary syndrome.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the diagnostic performance of the combination of copeptin and troponin for the exclusion of AMI in emergency patients with acute cardiac chief complaints and to assess diagnoses and outcome in copeptin-positive patients.
  
  
  METHODS
  In this prospective study, 537 consecutive patients with cardiac chief complaints were recruited from the ED. Blood samples were collected at admission.
  
  
  RESULTS
  The overall incidence of AMI in the study sample was 14.2% (n=76). In troponin-negative patients, copeptin showed a sensitivity of 76.9% (95% confidence interval (CI) 46.2-95.0), a specificity of 64.2% (95% CI 59.2-69.0), a positive predictive value (PPV) of 6.9% (95% CI 3.3-12.2) and an NPV of 98.8% (95% CI 96.5-99.8). The highest copeptin values were observed in patients with chronic heart failure, followed by ST-elevation myocardial infarction (STEMI), acute heart failure (AHF), pneumonia and non-STEMI (NSTEMI). A copeptin-value of above 10 pmol/l increased the risk of death within three months significantly (hazard ratio (HR)=5.42 (1.81-16.21) p=0.003).
  
  
  CONCLUSIONS
  Copeptin seems to be a promising biomarker for the initial evaluation of emergency patients with cardiac chief complaints. The study adds to the evidence that a single copeptin and troponin test at admission achieves a high NPV for ruling-out NSTEMI early in low-to-intermediate risk patients and thus--in combination with the clinical evaluation--seems to be of considerable relevance in emergency medicine.
authors.affiliation: Department of Cardiology and Division of Emergency Medicine, Campus Virchow Klinikum (CVK) and Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Germany Julia.searle@charite.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.affiliation: Department of Cardiology and Division of Emergency Medicine, Campus Virchow Klinikum (CVK) and Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.affiliation: Department of Cardiology, Havelland Kliniken, Klinik Nauen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.affiliation: Clinical Diagnostics, Thermo Fisher Scientific, Germany.
authors.forename: Joern O
authors.initials: JO
authors.lastname: Vollert
authors.affiliation: Department of Cardiology and Division of Emergency Medicine, Campus Virchow Klinikum (CVK) and Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: School of Public Health, James Cook University and Tropical Health Solutions Pty Ltd, Australia.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Muller
authors.affiliation: Department of Cardiology and Division of Emergency Medicine, Campus Virchow Klinikum (CVK) and Campus Mitte (CCM), Charité Universitätsmedizin Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006020:Glycopeptides / Q000097:blood* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood / Q000378:metabolism; D020107:Troponin T / Q000097:blood / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D019210:Troponin I; D020107:Troponin T; C048197:copeptins
keywords: Copeptin; acute myocardial infarction; chest pain; dyspnoea; emergency department; emergency medicine; rule-out