• Till Keller, Stergios Tzikas, Tanja Zeller, Ewa Czyz, Lars Lillpopp, Francisco M Ojeda, Alexander Roth, Christoph Bickel, Stephan Baldus, Christoph R Sinning, Philipp S Wild, Edith Lubos, Dirk Peetz, Jan Kunde, Oliver Hartmann, Andreas Bergmann, Felix Post, Karl J Lackner, Sabine Genth-Zotz, Viviane Nicaud, Laurence Tiret, Thomas F Münzel, and Stefan Blankenberg.
• Department of Medicine II, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
• J. Am. Coll. Cardiol. 2010 May 11;55(19):2096-106.

ObjectivesEarly identification of myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation.BackgroundThe aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to cardiac troponin in early evaluation of patients with suspected myocardial infarction.MethodsBetween January 2007 and July 2008, patients with suspected acute coronary syndrome were consecutively enrolled in this multicenter study. Copeptin, troponin T (TnT), myoglobin, and creatine kinase-myocardial band were determined at admission and after 3 and 6 h.ResultsOf 1,386 (66.4% male) enrolled patients, 299 (21.6%) had the discharge diagnosis of acute myocardial infarction, 184 (13.3%) presented with unstable angina, and in 903 (65.2%) an acute coronary syndrome could be excluded. Combined measurement of copeptin and TnT on admission improved the c-statistic from 0.84 for TnT alone to 0.93 in the overall population and from 0.77 to 0.9 in patients presenting within 3 h after chest pain onset (CPO) (p < 0.001). In this group the combination of copeptin with a conventional TnT provided a negative predictive value of 92.4%.ConclusionsIn triage of chest pain patients, determination of copeptin in addition to troponin improves diagnostic performance, especially early after CPO. Combined determination of troponin and copeptin provides a remarkable negative predictive value virtually independent of CPO time and therefore aids in early and safe rule-out of myocardial infarction.Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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