Diagnostic Performance of Copeptin in Patients With Acute Nontraumatic Chest Pain: BWH-TIMI ED Chest Pain Study

Study Questions:

What is the performance of copeptin (the C-terminal fragment of vasopressin precursor hormone), both alone and in addition to cardiac troponin, in the diagnosis of myocardial infarction (MI) in patients presenting to the emergency department (ED) with acute nontraumatic chest pain?

Methods:

This was a prospective, single-center study of patients (n = 405) who presented within 24 hours of onset of nontraumatic chest pain suspicious for acute coronary syndrome (ACS). Blood samples for measurement of copeptin and troponin (measured using the local hospital assay as well as a sensitive assay) were collected at enrollment and serially at 4-6 hours and 12-24 hours. Final presenting diagnosis for each patient was adjudicated by a clinical endpoints committee. Sensitivity, specificity, positive predictive value, and negative predictive value were assessed.

Results:

MI was diagnosed in 25.7% of patients. The area under the receiver operating characteristic curve (AUC) for copeptin was 0.60 (95% confidence interval, 0.54-0.66), significantly less than the AUC for local cardiac troponin (0.92) or sensitive cardiac troponin (0.96). The addition of copeptin to either troponin assay did not significantly improve the AUC as compared to cardiac troponin alone. In 111 early presenters to the ED (≤6 hours from chest pain onset), copeptin still did not improve the diagnostic performance for detecting MI.

Conclusions:

The authors concluded that copeptin alone, or in combination with cardiac troponin, does not provide any detectable improvement in the diagnosis of MI.

Perspective:

The authors provide convincing evidence that copeptin, either alone or in combination with cardiac troponin, does not improve diagnostic performance for detection of MI. As there were a relatively small number of early presenters in this study, future research should clarify the role of copeptin in this group. It is plausible that copeptin could be helpful for the diagnosis of MI in early presenters, as it increases within 30 minutes and peaks at 90 minutes from the onset of myocardial injury.

Clinical Topics: Acute Coronary Syndromes

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Vasopressins, Chest Pain, Emergency Service, Hospital, Troponin


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