Copeptin Helps in the Early Detection of Patients With Acute Myocardial Infarction Primary Results of the CHOPIN Trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction)

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Article

Maisel, Alan^1,2  Mueller, Christian³  Neath, Sean-Xavier²  Christenson, Robert H.⁴  Morgenthaler, Nils G.⁵  McCord, James⁶  Nowak, Richard M.⁶  Vilke, Gary²  Daniels, Lori B.²  Hollander, Judd E.⁷  Apple, Fred S.⁸  Cannon, Chad⁹  Nagurney, John T.¹⁰  Schreiber, Donald¹¹  deFilippi, Christopher⁴  Hogan, Christopher¹²  Diercks, Deborah B.¹³  Stein, John C.¹⁴  Headden, Gary¹⁵  Limkakeng, Alexander T., Jr.¹⁶  Anand, Inder¹⁷  Wu, Alan H. B.¹⁴  Papassotiriou, Jana¹⁸  Hartmann, Oliver¹⁸  Ebmeyer, Stefan¹⁸  Clopton, Paul¹  Jaffe, Allan S.¹⁹  Peacock, W. Frank²⁰ 

[1] VA San Diego Healthcare Syst, San Diego, CA USA

[2] Univ Calif San Diego, San Diego, CA 92103 USA

[3] Univ Basel Hosp, CH-4031 Basel, Switzerland

[4] Univ Maryland, Sch Med, Baltimore, MD 21201 USA

[5] Campus Virchow Klinikum, Charite, Berlin, Germany

[6] Henry Ford Hlth Syst, Detroit, MI USA

[7] Univ Penn, Philadelphia, PA 19104 USA

[8] Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA

[9] Univ Kansas Hosp, Kansas City, KS USA

[10] Massachusetts Gen Hosp, Boston, MA 02114 USA

[11] Stanford Univ, Sch Med, Palo Alto, CA 94304 USA

[12] Virginia Commonwealth Univ, Richmond, VA USA

[13] Univ Calif Davis, Med Ctr, Sacramento, CA 95817 USA

[14] Univ Calif San Francisco, San Francisco, CA 94143 USA

[15] Med Univ S Carolina, Charleston, SC 29425 USA

[16] Duke Univ, Med Ctr, Durham, NC USA

[17] VA Minneapolis, Minneapolis, MN USA

[18] Thermo Fisher Sci BRAHMS GmbH, Thermo Sci Biomarkers, Hennigsdorf, Germany

[19] Mayo Clin, Rochester, MN USA

[20] Baylor Coll Med, Houston, TX 77030 USA

关键词: copeptin;    emergency department;    myocardial infarction;    quality improvement;    troponin;   

DOI  :  10.1016/j.jacc.2013.04.011

来源: Elsevier

【 摘 要 】

Objectives The goal of this study was to demonstrate that copeptin levels <14 pmol/L allow ruling out acute myocardial infarction (AMI) when used in combination with cardiac troponin I (cTnI) <99th percentile and a nondiagnostic electrocardiogram at the time of presentation to the emergency department (ED). Background Copeptin is secreted from the pituitary early in the course of AMI. Methods This was a 16-site study in 1,967 patients with chest pain presenting to an ED within 6 hours of pain onset. Baseline demographic characteristics and clinical data were collected prospectively. Copeptin levels and a contemporary sensitive cTnI (99th percentile 40 ng/l; 10% coefficient of variation 0.03 mu g/l) were measured in a core laboratory. Patients were followed up for 180 days. The primary outcome was diagnosis of AMI. Final diagnoses were adjudicated by 2 independent cardiologists blinded to copeptin results. 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 of 99.2% (95% confidence interval: 98.5 to 99.6). AMIs not detected by the initial cTnI alone were picked up with copeptin >14 pmol/l in 23 (72%) of 32 patients. Non-ST-segment elevation myocardial infarctions undetected by cTnI at 0 h were detected with copeptin >14 pmol/l in 10 (53%) of 19 patients. Projected average time-to-decision could be reduced by 43% (from 3.0 h to 1.8 h) 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 (all p < 0.0001). Conclusions Adding copeptin to cTnI allowed safe rule out of AMI with a negative predictive value >99% in patients presenting with suspected acute coronary syndromes. This combination has the potential to rule out AMI in 58% of patients without serial blood draws. (Investigation of the Biomarker Copeptin in Patients With Acute Myocardial Infarction [NCT00952744]) (C) 2013 by the American College of Cardiology Foundation

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