• Fabio Stallone, Raphael Twerenbold, Karin Wildi, Tobias Reichlin, Maria Rubini Gimenez, Philip Haaf, Nicole Fuechslin, Petra Hillinger, Cedric Jaeger, Philipp Kreutzinger, Christian Puelacher, Milos Radosavac, Zoraida Moreno Weidmann, Berit Moehring, Ursina Honegger, Carmela Schumacher, Kris Denhaerynck, Christiane Arnold, Roland Bingisser, Jörn Ole Vollert, Stefan Osswald, and Christian Mueller.
• Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland Department of Cardiology, University Hospital Basel, Basel, Switzerland.
• Heart. 2014 Nov 1;100(21):1708-14.

ObjectiveCopeptin, a quantitative marker of endogenous stress, seems to provide incremental value in addition to cardiac troponin in the early rule-out of acute myocardial infarction (AMI). Prevalence, characteristics and outcome of acute chest pain patients with causes other than AMI and elevated copeptin are poorly understood.MethodsA total of 984 consecutive patients with non-cardiac chest pain were selected from a prospective multicentre study of acute chest pain patients presenting to the emergency department. Levels of copeptin were determined in a blinded fashion and considered elevated if above 13 pmol/L (the 97,5th centile of healthy individuals). The final diagnosis was adjudicated by two independent cardiologists. Median duration of follow-up was 756 days.ResultsElevated copeptin levels were seen in 215 patients (22%). In comparison to patients with normal copeptin levels, patients with elevated levels were older, had more pre-existing cardiac and non-cardiac disorders, more silent cardiomyocyte injury and increased haemodynamic stress as quantified by levels of high-sensitivity cardiac troponin T (9.6 ng/L (3.6-18.3) vs 5.8 ng/L (2.9-9.4)) and B-type natriuretic peptide (75 ng/L (37-187) vs 35 ng/L (15-77)) (both p<0.001), more electrocardiographic abnormalities, more often an adjudicated diagnosis of gastroesophageal reflux or bronchitis/pneumonia and higher 2- year mortality (HR 2.9, 95% CI 1.5  to 5.7). The increased mortality rate seemed to be largely explained by age and comorbidities.ConclusionsElevated levels of copeptin are present in about one in five patients with non-cardiac chest pain and are associated with aging, cardiac and non-cardiac comorbidities as well as mortality.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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