Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial.

Published

Journal Article

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.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.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).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.

Full Text

Duke Authors

Cited Authors

  • Marston, NA; Shah, KS; Mueller, C; Neath, S-X; Christenson, RH; McCord, J; Nowak, RM; Daniels, LB; Hollander, JE; Apple, F; Nagurney, J; Schreiber, D; deFilippi, C; Diercks, D; Limkakeng, A; Anand, IS; Wu, AHB; Jaffe, AS; Peacock, WF; Maisel, AS

Published Date

  • January 2016

Published In

Volume / Issue

  • 33 / 1

Start / End Page

  • 23 - 29

PubMed ID

  • 26105583

Pubmed Central ID

  • 26105583

Electronic International Standard Serial Number (EISSN)

  • 1472-0213

International Standard Serial Number (ISSN)

  • 1472-0205

Digital Object Identifier (DOI)

  • 10.1136/emermed-2015-204692

Language

  • eng