Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction

Objectives The purpose of this study was to examine the incremental value of copeptin for rapid rule out of acute myocardial infarction (AMI). Background The rapid and reliable exclusion of AMI is a major unmet clinical need. Copeptin, the C-terminal part of the vasopressin prohormone, as a marker of acute endogenous stress may be useful in this setting. Methods In 487 consecutive patients presenting to the emergency department with symptoms suggestive of AMI, we measured levels of copeptin at presentation, using a novel sandwich immunoluminometric assay in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists using all available data. Results The adjudicated final diagnosis was AMI in 81 patients (17%). Copeptin levels were significantly higher in AMI patients compared with those in patients having other diagnoses (median 20.8 pmol/l vs. 6.0 pmol/l, p < 0.001). The combination of troponin T and copeptin at initial presentation resulted in an area under the receiver-operating characteristic curve of 0.97 (95% confidence interval: 0.95 to 0.98), which was significantly higher than the 0.86 (95% confidence interval: 0.80 to 0.92) for troponin T alone (p < 0.001). A copeptin level < 14 pmol/l in combination with a troponin T <= 0.01 mu g/l correctly ruled out AMI with a sensitivity of 98.8% and a negative predictive value of 99.7%. Conclusions The additional use of copeptin seems to allow a rapid and reliable rule out of AMI already at presentation and may thereby obviate the need for prolonged monitoring and serial blood sampling in the majority of patients. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [ APACE]; NCT00470587) (J Am Coll Cardiol 2009; 54: 60-8) (C) 2009 by the American College of Cardiology Foundation