Copeptin for early diagnosis of myocardial infarction

ACS = acute coronary syndrome AMI = acute myocardial infarction CK = creatine kinase COPD = chronic obstructive pulmonary disease ECG = electrocardiogram NSTEMI = non-ST-segment myocardial infarction STEMI = ST-segment elevation myocardial infarctio TRACE ® = Time-Resolved Amplified Cryptate Emission Troponin = Troponin Ic Summary Background: Early identification of myocardial infarction is crucial in chest pain patients.Objective: Our goal was to evaluate if copeptin allows the ruling out of myocardial infarction (AMI) when used with cardiac troponin Ic (troponin) in the emergency department.Methods: Patients with suspected acute coronary syndrome (ACS) were enrolled in this pilot trial.Copeptin and troponin were determined at admission, and 6 h later for troponin.Results: A total of 125 patients with a mean age of 60 ± 15 years were enrolled.Chest pain was present in 94 patients (75%) and other symptoms compatible with cardiac ischaemia in 25 (20%).Four groups were identified: 15 patients in group 1 had positive copeptin and positive troponin, 29 patients in group 2 had positive copeptin and negative troponin, 7 patients in group 3 had negative copeptin and positive troponin, and 74 patients in group 4 had both copeptin and troponin negative.Patients in group 1, 2 and 3 had a high incidence of STEMI and NSTEMI.In group 4, no patient experienced adverse events.Negative predictive value was 100% for the combined measurement of troponin and copeptin.A 3-month follow-up was completed without adverse events for patients of group 4.Conclusion: Combined determination of troponin and copeptin on admission in patients presenting early (<3 hours but >30 minutes) after onset of symptoms suspect of AMI provides a high negative predictive value.This combination might improve early rule-out of AMI and makes copeptin a useful complement to conventional troponin in the emergency department.