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)

Alan Maisel, Christian Mueller, Sean Xavier Neath, Robert H. Christenson, Nils G. Morgenthaler, James McCord, Richard M. Nowak, Gary Vilke, Lori B. Daniels, Judd E. Hollander, Fred S. Apple, Chad Cannon, John T. Nagurney, Donald Schreiber, Christopher Defilippi, Christopher Hogan, Deborah B. Diercks, John C. Stein, Gary Headden, Alexander T. LimkakengInder Anand, Alan H B Wu, Jana Papassotiriou, Oliver Hartmann, Stefan Ebmeyer, Paul Clopton, Allan S. Jaffe, W. Frank Peacock

Research output: Contribution to journalArticle

106 Scopus citations

Abstract

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 μg/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]).

Original languageEnglish (US)
Pages (from-to)150-160
Number of pages11
JournalJournal of the American College of Cardiology
Volume62
Issue number2
DOIs
StatePublished - Jul 9 2013

Keywords

  • copeptin
  • emergency department
  • myocardial infarction
  • quality improvement
  • troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of '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)'. Together they form a unique fingerprint.

  • Cite this

    Maisel, A., Mueller, C., Neath, S. X., Christenson, R. H., Morgenthaler, N. G., McCord, J., Nowak, R. M., Vilke, G., Daniels, L. B., Hollander, J. E., Apple, F. S., Cannon, C., Nagurney, J. T., Schreiber, D., Defilippi, C., Hogan, C., Diercks, D. B., Stein, J. C., Headden, G., ... Peacock, W. F. (2013). 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, 62(2), 150-160. https://doi.org/10.1016/j.jacc.2013.04.011