Copeptin Helps in the Early Detection of Patients With Acute Myocardial Infarction: The Primary Results of the CHOPIN Trial

Study Questions:

Is copeptin a useful biomarker for early detection of acute myocardial infarction (AMI)?

Methods:

Copeptin and cardiac troponin I (cTnI) levels were measured in 1,967 patients presenting to an emergency department within 6 hours of the onset of chest pain. The primary outcome was diagnosis of AMI.

Results:

AMI was the final diagnosis in 156 patients (7.9%). A negative copeptin and cTnI at baseline ruled out AMI for 58% of patients, with a negative predictive value (NPV) of 99.2%. AMIs not detected by the initial cTnI alone were picked up with copeptin >14 pmol/L in 23/32 patients (72%). Non−ST-segment elevation MIs (NSTEMIs) undetected by cTnI at 0 hours were detected with copeptin >14 pmol/L in 10/19 patients (53%). Projected average time-to-decision could be reduced by 43% (from 3.0 hours to 1.8 hours) by the early rule out of 58% of patients. Both abnormal copeptin and cTnI were predictors of death at 180 days (p < 0.0001 for both, c-index 0.784 and 0.800, respectively). Both were independent of age and each other and provided additional predictive value (p < 0.0001).

Conclusions:

The authors concluded that adding copeptin to cTnI allowed safe rule out of AMI with a NPV >99% in patients presenting with suspected acute coronary syndrome. It has the potential to rule out AMI in 58% of patients without serial blood draws.

Perspective:

Copeptin is the c-terminal portion of the arginine vasopressin (AVP) precursor peptide. Because copeptin is more stable than AVP, it may represent a more useful biomarker of hemodynamic disturbances. Copeptin levels have previously been shown to rise rapidly in the circulation following AMI and to decline over the subsequent 2-5 days. This study demonstrates that copeptin levels may be useful (in addition to cTns) in the rapid triage of patients presenting with chest pain, and may also provide additional short-term prognostic information. The clinical utility/cost savings of incorporating copeptin measurements into chest pain evaluation algorithms will require further study.

Clinical Topics: Acute Coronary Syndromes, ACS and Cardiac Biomarkers

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Biological Markers, Chest Pain, Troponin I, Emergency Service, Hospital, Triage


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