Nicholas A Marston1, Kevin S Shah1, Christian Mueller2, Sean-Xavier Neath1, Robert H Christenson3, James McCord4, Richard M Nowak4, Lori B Daniels1, Judd E Hollander5, Fred Apple6, John Nagurney7, Donald Schreiber8, Christopher deFilippi3, Deborah Diercks9, Alexander Limkakeng10, Inder S Anand11, Alan H B Wu12, Allan S Jaffe13, W Frank Peacock14, Alan S Maisel15. 1. University of California, San Diego, California, USA. 2. University Hospital Basel, Basel, Switzerland. 3. University of Maryland, Baltimore, Maryland, USA. 4. Henry Ford Health System, Detroit, Michigan, USA. 5. Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 6. Hennepin County Medical Center, Minneapolis, Minnesota, USA. 7. Massachusetts General Hospital, Boston, Massachusetts, USA. 8. Stanford University School of Medicine, Palo Alto, California, USA. 9. University of California, Davis Medical Center, Sacramento, California, USA. 10. Duke University Medical Center, Durham, North Carolina, USA. 11. Veterans Affairs Medical Center, Minneapolis, Minnesota, USA. 12. University of California, San Francisco, California, USA. 13. Mayo Clinic, Rochester, Minnesota, USA. 14. Baylor College of Medicine, Houston, Texas, USA. 15. University of California, San Diego, California, USA Veterans Affairs Medical Center, San Diego, California, USA.
Abstract
BACKGROUND: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. METHODS: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. RESULTS: Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006). CONCLUSIONS: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND:Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. METHODS: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. RESULTS: Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006). CONCLUSIONS:Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
acute myocardial infarct; chest - non trauma; diagnosis
Authors: Ji Hun Jeong; Yiel Hea Seo; Jeong Yeal Ahn; Kyung Hee Kim; Ja Young Seo; Ka Yeong Chun; Yong Su Lim; Pil Whan Park Journal: Ann Lab Med Date: 2020-01 Impact factor: 3.464
Authors: Michael John Stacey; Simon K Delves; Sophie E Britland; Adrian J Allsopp; Stephen J Brett; Joanne L Fallowfield; David R Woods Journal: Eur J Appl Physiol Date: 2017-10-27 Impact factor: 3.078
Authors: Hilal Erken Pamukcu; Mehmet Ali Felekoğlu; Engin Algül; Haluk Furkan Şahan; Faruk Aydinyilmaz; İlkin Guliyev; Saadet Demirtaş İnci; Nail Burak Özbeyaz; Ali Nallbani Journal: Medicine (Baltimore) Date: 2020-12-11 Impact factor: 1.817