RT Journal Article
SR Electronic
T1 Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 23
OP 29
DO 10.1136/emermed-2015-204692
VO 33
IS 1
A1 Nicholas A Marston
A1 Kevin S Shah
A1 Christian Mueller
A1 Sean-Xavier Neath
A1 Robert H Christenson
A1 James McCord
A1 Richard M Nowak
A1 Lori B Daniels
A1 Judd E Hollander
A1 Fred Apple
A1 John Nagurney
A1 Donald Schreiber
A1 Christopher deFilippi
A1 Deborah Diercks
A1 Alexander Limkakeng
A1 Inder S Anand
A1 Alan HB Wu
A1 Allan S Jaffe
A1 W Frank Peacock
A1 Alan S Maisel
YR 2016
UL http://emj.bmj.com/content/33/1/23.abstract
AB 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.