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Am J Cardiol. 2014 May 1;113(9):1581-91. doi: 10.1016/j.amjcard.2014.01.436. Epub 2014 Feb 13.

A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction.

Author information

  • 1MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia.
  • 2Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
  • 3Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain; Research Group: "Emergencies: Processes and Pathologies", IDIBAPS, Barcelona, Catalonia, Spain.
  • 4Emergency Department, Short Stay Unit and Hospital at Home Care, Hospital General Universitario de Alicante, Alicante, Spain.
  • 5Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
  • 6Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Frankenhausen, Germany.
  • 7Départment des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
  • 8Département de Biochimie, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
  • 9Clinical Chemistry Laboratory, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France.
  • 10Cardiology Department, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France; Cardiology Department, Paris XIII University, Avicenne Hospital, Bobigny, France.
  • 11Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  • 12Emergency Department, University Hospital of Rangueil, Toulouse, France; Team5 INSERM 1027, Toulouse University, Toulouse, France.
  • 13Department of Cardiology, University Hospital Basel, Basel, Switzerland; Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
  • 14Department of Cardiology, University Hospital Basel, Basel, Switzerland.
  • 15Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
  • 16MedStar Heart Institute, Medstar Washington Hospital Center, MedStar Cardiovascular Research Network, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net.

Abstract

Multiple studies have evaluated copeptin, a surrogate for arginine vasopressin, in the diagnosis of acute myocardial infarction (AMI) with mixed results. A systematic review and collaborative meta-analysis were performed for diagnosis of AMI and assessment of prognosis in patients presenting to the emergency department with chest pain. MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing copeptin in such patients. Study investigators were contacted, and many provided previously unpublished data. Random-effects methods were used to compare the data for copeptin, troponin, and their combination. There were a total of 9,244 patients from the 14 included studies. Mean age was 62 years; 64% were men; and 18.4% were ultimately diagnosed with AMI. Patients with AMI had a higher presentation copeptin level than those without AMI (22.8 vs 8.3 pmol/L, respectively, p <0.001). Although troponin had better diagnostic accuracy than copeptin for AMI, the combination of copeptin and troponin significantly improved the sensitivity (0.905 [0.888 to 0.921] vs 0.686 [0.661 to 0.710], respectively, p <0.001) and negative predictive value (0.97 [0.964 to 0.975] vs 0.93 [0.924 to 0.936], respectively, p <0.001) compared with troponin alone. Elevation in copeptin carried a similar risk of all-cause mortality to an elevation in troponin (odds ratio 5.84 vs 6.74, respectively, p = 0.67). In conclusion, copeptin not only identifies patients at risk of all-cause mortality, but its addition to troponin improved the sensitivity and negative likelihood ratio for diagnosis of AMI compared with troponin alone. Thus, copeptin may help identify patients who may be safely discharged early from the emergency department.

Copyright © 2014 Elsevier Inc. All rights reserved.

PMID:
24731654
[PubMed - indexed for MEDLINE]
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