title: Copeptin and high-sensitivity cardiac troponin to exclude severe coronary stenosis in patients with chest pain and coronary artery disease.
abstract: OBJECTIVE
  The purpose was to evaluate the incremental value of copeptin associated with high-sensitivity cardiac T troponin (hs-cTnT) to exclude severe coronary stenosis in patients with coronary artery disease (CAD) and acute chest pain.
  
  
  METHODS
  This monocentric prospective study included 96 consecutive patients with documented CAD and admitted to the intensive care unit for chest pain lasting for less than 10 hours. Acute coronary syndrome was excluded with electrocardiography and baseline hs-cTnT values <14 ng/L with dynamic changes ≤50% 3 hours later (Roche Diagnostics, COBAS 8000). Copeptin (Thermofisher, Kryptor Compact) was considered as positive when >10 pmol/L. Primary end point was severe coronary stenosis at coronary angiography or myocardial ischemia on perfusion single-photon emission computed tomography imaging.
  
  
  RESULTS
  Mean age of patients was 60 ± 13.8 years, and the mean time between chest pain onset and blood samples of copeptin was 4.2 ± 2.7 hours. According to clinical decision, coronary angiography was performed in 71 patients (73.9%) and severe stenosis diagnosed in 14 of them (14.6%). No ischemia was detected on single-photon emission computed tomography imaging (n = 25). Among the 69 patients with a negative kinetic of hs-cTnT and a negative baseline copeptin, 5 (7.4%) had a severe stenosis (negative predictive value, 0.93; 95% confidence interval, 0.87-0.99), 4 of them related to in-stent restenosis (negative predictive value for exclusion of native coronary stenosis, 0.98; 95% confidence interval, 0.93-1).
  
  
  CONCLUSIONS
  For patients with preexisting CAD and acute chest pain, and once acute coronary syndrome is excluded, copeptin provides a useful additional triage strategy to exclude severe coronary stenosis, particularly those not related to in-stent restenosis.
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France. Electronic address: f-leclercq@chu-montpellier.fr.
authors: Florence
authors: F
authors: Leclercq
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Anais
authors: A
authors: Iemmi
authors: Department of biochimy, Lapeyronie hospital, University hospital of Montpellier, Montpellier, France.
authors: Nils
authors: N
authors: Kusters
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Benoit
authors: B
authors: Lattuca
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Guillaume
authors: G
authors: Cayla
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Jean-Christophe
authors: JC
authors: Macia
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Francois
authors: F
authors: Roubille
authors: Department of cardiology, Arnaud de Villeneuve hospital, University hospital of Montpellier, Montpellier, France.
authors: Mariama
authors: M
authors: Akodad
authors: Department of biochimy, Lapeyronie hospital, University hospital of Montpellier, Montpellier, France.
authors: Jean-Paul
authors: JP
authors: Cristol
authors: Department of biochimy, Lapeyronie hospital, University hospital of Montpellier, Montpellier, France.
authors: Anne-Marie
authors: AM
authors: Dupuy
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins