• Am J Emerg Med · Mar 2012

    Multicenter Study Clinical Trial

    Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.

    • Patrick Ray, Sandrine Charpentier, Camille Chenevier-Gobeaux, Tobias Reichlin, Raphael Twerenbold, Yann-Erick Claessens, Patrick Jourdain, Bruno Riou, and Christian Mueller.
    • Department of Emergency Medicine, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM UMRS 956, Université Pierre et Marie Curie-Paris 6, 75013, Paris, France. patrick.ray@tnn.aphp.fr
    • Am J Emerg Med. 2012 Mar 1;30(3):440-8.

    PurposeThe main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD).Patients And MethodPatients with a previous history of CAD presenting in the emergency department with acute chest pain lasting for 6 hours or less suggestive of non-ST-segment elevation AMI and negative cTn were selected. Levels of copeptin were blindly measured at presentation. The diagnosis was adjudicated by 2 independent experts using all available data including cTn.ResultsA total of 451 patients were included (mean age, 67±14; 330 [73%] men). The adjudicated final diagnosis was AMI in 36 (8%) patients, unstable angina in 131 (29%), and other diagnosis in 284 (63%). A negative cTn combined with a copeptin value lower than 10.7 pmol/L at presentation was able to rule out AMI, with a negative predictive value of 98% (95% confidence interval, 95%-99%).ConclusionIn triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.Copyright © 2012 Elsevier Inc. All rights reserved.

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