title: Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial.
abstract: BACKGROUND
  Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear.
  
  
  METHODS
  The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation.
  
  
  RESULTS
  Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006).
  
  
  CONCLUSIONS
  Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.
authors.affiliation: University of California, San Diego, California, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Marston
authors.affiliation: University of California, San Diego, California, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Shah
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: University of California, San Diego, California, USA.
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.affiliation: University of Maryland, Baltimore, Maryland, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.affiliation: Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.affiliation: University of California, San Diego, California, USA.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Apple
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nagurney
authors.affiliation: Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: University of Maryland, Baltimore, Maryland, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: deFilippi
authors.affiliation: University of California, Davis Medical Center, Sacramento, California, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Limkakeng
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: University of California, San Francisco, California, USA.
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: University of California, San Diego, California, USA Veterans Affairs Medical Center, San Diego, California, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D014336:Troponin; C048197:copeptins
keywords: acute myocardial infarct; chest - non trauma; diagnosis