Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
Am J Emerg Med. 2012 Mar;30(3):440-8
Authors: Ray P, Charpentier S, Chenevier-Gobeaux C, Reichlin T, Twerenbold R, Claessens YE, Jourdain P, Riou B, Mueller C
PURPOSE: The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD).
PATIENTS AND METHOD: Patients with a previous history of CAD presenting in the emergency department with acute chest pain lasting for 6 hours or less suggestive of non-ST-segment elevation AMI and negative cTn were selected. Levels of copeptin were blindly measured at presentation. The diagnosis was adjudicated by 2 independent experts using all available data including cTn.
RESULTS: A total of 451 patients were included (mean age, 67 ± 14; 330 [73%] men). The adjudicated final diagnosis was AMI in 36 (8%) patients, unstable angina in 131 (29%), and other diagnosis in 284 (63%). A negative cTn combined with a copeptin value lower than 10.7 pmol/L at presentation was able to rule out AMI, with a negative predictive value of 98% (95% confidence interval, 95%-99%).
CONCLUSION: In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
PMID: 22402136 [PubMed - in process]