Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department<sup>1)</sup>

Bahrmann, Philipp; Bahrmann, Anke; Breithardt, Ole A.; Daniel, Werner G.; Christ, Michael; Sieber, Cornel; Bertsch, Thomas

doi:10.1515/cclm-2012-0401

Cited by 26 publications

(34 citation statements)

References 28 publications

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“…Finally, the only participant who died is the patient who had the highest value of copeptin, which is consistent with the highlight of the studies showing a prognostic role for copeptin 19 25 27 29…”

Section: Discussionsupporting

confidence: 86%

“…Moreover, for the patients from the FAST II and FASTER I studies, copeptin did not detect 18 of the 27 patients with NSTEMI with troponin below the 99th centile (sensitivity=33% in this subgroup). Bahrmann et al 25 and Lotze et al 14 found a NPV of 100%, but each of these studies included only one patient with NSTEMI with hs-cTnT below the cut-off defined. Thelin et al 30 found a significant difference between sensitivities of single troponin versus the combination of troponin and copeptin.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

et al. 2014

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ObjectiveTo determine whether copeptin-us can rule out diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) without prolonged monitoring and serial blood sampling in patients with high-sensitive cardiac troponin I (hs-cTnT) below the 99th centile at presentation to the emergency department (ED).DesignProspective, non-randomised, individual blinded diagnostic accuracy study.SettingTwo EDs of a rural region of France.ParticipantsPatients with chest pain suspected of NSTEMI with onset within the last 12 h were considered for enrolment.InterventionsSerial clinical, electrographical and biochemical investigations were performed at admission and after 2, 4, 6 and 12 h. Hs-cTnT was measured using an assay with Dimension VISTA, Siemens. Copeptin was measured by the BRAHMS copeptin-us assay on the KRYPTOR Compact Plus system. The follow-up period was 90 days.Primary and secondary outcome measuresCopeptin, troponin, myoglobin and creatine kinase values. Clinical and paraclinical events. The final diagnosis was adjudicated blinded to copeptin result.ResultsDuring 12 months, 102 patients were analysed. Final diagnosis was NSTEMI for 7.8% (n=8), unstable angina for 3.9% (n=4), cardiac but non-coronary artery disease for 8.8% (n=9), non-cardiac chest pain for 52% (n=53) and unknown for 27.5% (n=28). There was no statistical difference for copeptin values between patients with NSTEMI and others (respectively 5.5 pmol/L IQR (3.1–7.9) and 6.5 pmol/L IQR (3.9–12.1), p=0.49). Only one patient with NSTEMI had a copeptin value above the cut-off of 95th centile at admission.ConclusionsIn this study, copeptin does not add a diagnostic value at admission to ED for patients with suspected acute coronary syndrome without ST-segment elevation and with hs-cTnT below the 99th centile.Trial registration numberClinicaltrials.gov identifier: NCT01334645.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

et al. 2014

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“…Thus, the time point of copeptin testing is crucial for this concept. In studies with most patients presenting late after the onset of symptoms, copeptin testing is unlikely to provide added value to troponin testing, as most patients will already be troponin-positive at admission to the ED or CPU [23•]. This was taken to an extreme in a study by Karakas et al [24•] where copeptin was measured at a median of 4.3 h after presentation to the ED in a study which was primarily set up to evaluate CT angiography in patients with suspected ACS.…”

Section: Time Point Of Blood Samplingmentioning

confidence: 99%

Copeptin—Marker of Acute Myocardial Infarction

Möckel

Searle

2014

Curr Atheroscler Rep

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The concentration of copeptin, the C-terminal part of pro-arginine vasopressin, has been shown to increase early after acute and severe events. Owing to complementary pathophysiology and kinetics, the unspecific marker copeptin, in combination with highly cardio-specific troponin, has been evaluated as an early-rule-out strategy for acute myocardial infarction in patients presenting with signs and symptoms of acute coronary syndrome. Overall, most studies have reported a negative predictive value between 97 and 100 % for the diagnosis of acute myocardial infarction in low- to intermediate-risk patients with suspected acute coronary syndrome. Additionally, a recent multicenter, randomized process study, where patients who tested negative for copeptin and troponin were discharged from the emergency department, showed that the safety of the new process was comparable to that of the current standard process. Further interventional trials and data from registries are needed to ensure the effectiveness and patient benefit of the new strategy.

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“…The temporal release pattern of copeptin in our study was characterized by increased values very early after symptom onset, a peak in ambulance or at admission, and a rapid decrease within the first hours after admission. Copeptin concentrations returned to baseline in all diagnoses after 12-36 h. Several studies have shown that copeptin values are increased in patients with AMI at admission, especially in early presenters (4,6,10,11,(17)(18)(19)(20)(21)(22)(23). We were able to illustrate for the first time that copeptin values were al- Thirty-five patients with AMI and SOT ≤180 min and 20 patients with AMI and SOT >180 min were included in this study.…”

Section: Discussionmentioning

confidence: 61%

Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction

Slagman¹,

Searle²,

Müller

et al. 2015

Clinical Chemistry

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BACKGROUND The release pattern of copeptin during the initial 36 h of spontaneous acute myocardial infarction (AMI) has received relatively little investigation but may provide important information on optimal timing of diagnostic measurements. METHODS We investigated the release pattern of copeptin and cardiac troponin T in patients with suspected acute coronary syndrome (ACS). Blood samples were collected in the ambulance, at admission, and after 2, 4, 6, and 12–36 h. Copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in heparin plasma samples. RESULTS Of 93 patients studied, 37 (39.8%) had ST-elevation myocardial infarction (STEMI), 20 (21.5%) non-STEMI, 20 (21.5%) unstable angina pectoris (UAP), and 16 (17.2%) non-ACS diagnoses. Peak copeptin concentrations were detected during ambulance transport for NSTEMI patients [median 94.0 pmol/L, interquartile range (IQR) 53.3–302.1 pmol/L] and at admission for patients with STEMI (70.0 pmol/L, 22.0–144.8 pmol/L). In patients with AMI, copeptin decreased significantly over time (P < 0.0001). This was true for patients with STEMI (P = 0.005) and non-STEMI (P = 0.021). The diagnostic performance during ambulance transport was similar for hs-cTnT (area under the ROC curve 0.75, 95% CI 0.62–0.88) and copeptin (0.81, 0.69–0.92). In early presenters (n = 52), no patient with AMI was initially (in ambulance or at admission) negative for copeptin, resulting in an area under the ROC curve of 0.963 for ambulance values and a negative predictive value of 100%. In late presenters, the negative predictive value of copeptin was 50% in ambulance and at admission. CONCLUSIONS Our analysis is the first to show a consistent early increase in copeptin at first medical contact in the ambulance and a decrease to routine values within 12–36 h in patients presenting early with spontaneous AMI.

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Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department¹⁾

Abstract: In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

Cited by 26 publications

References 28 publications

Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

Copeptin—Marker of Acute Myocardial Infarction

Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction

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Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department1)

Abstract: In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

Cited by 26 publications

References 28 publications

Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

Diagnostic accuracy of copeptin sensitivity and specificity in patients with suspected non-ST-elevation myocardial infarction with troponin I below the 99th centile at presentation

Copeptin—Marker of Acute Myocardial Infarction

Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction

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Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department¹⁾