Focus Issue: Biomarkers in Cardiovascular Disease
Clinical Research: Biomarkers in ACS
Copeptin Improves Early Diagnosis of Acute Myocardial Infarction

https://doi.org/10.1016/j.jacc.2010.01.029Get rights and content
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Objectives

Early identification of myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation.

Background

The aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to cardiac troponin in early evaluation of patients with suspected myocardial infarction.

Methods

Between January 2007 and July 2008, patients with suspected acute coronary syndrome were consecutively enrolled in this multicenter study. Copeptin, troponin T (TnT), myoglobin, and creatine kinase-myocardial band were determined at admission and after 3 and 6 h.

Results

Of 1,386 (66.4% male) enrolled patients, 299 (21.6%) had the discharge diagnosis of acute myocardial infarction, 184 (13.3%) presented with unstable angina, and in 903 (65.2%) an acute coronary syndrome could be excluded. Combined measurement of copeptin and TnT on admission improved the c-statistic from 0.84 for TnT alone to 0.93 in the overall population and from 0.77 to 0.9 in patients presenting within 3 h after chest pain onset (CPO) (p < 0.001). In this group the combination of copeptin with a conventional TnT provided a negative predictive value of 92.4%.

Conclusions

In triage of chest pain patients, determination of copeptin in addition to troponin improves diagnostic performance, especially early after CPO. Combined determination of troponin and copeptin provides a remarkable negative predictive value virtually independent of CPO time and therefore aids in early and safe rule-out of myocardial infarction.

Key Words

chest pain
copeptin
diagnosis
myocardial infarction
troponin

Abbreviations and Acronyms

ACS
acute coronary syndrome
AMI
acute myocardial infarction
AUC
area under the curve
AVP
arginin-vasopressin
CK-MB
creatine kinase-myocardial band
CPO
chest pain onset
CV
coefficient of variation
ECG
electrocardiogram/electrocardiographic
MI
myocardial infarction
NCCP
noncoronary chest pain
NPV
negative predictive value
NT-proBNP
N-terminal pro-brain natriuretic peptide
PPV
positive predictive value
ROC
receiver operating characteristic
TnI
troponin I
TnT
troponin T
UAP
unstable angina pectoris

Cited by (0)

The current study is funded through the research programs “Wissen schafft Zukunft”and “Schwerpunkt Vaskuläre Prävention”of the Johannes Gutenberg-University of Mainz and an unrestricted grant of the B.R.A.H.M.S. AG, Germany. Jan Kunde, Oliver Hartmann, and Andreas Bergmann are employed by B.R.A.H.M.S. AG, Germany.