Copeptin—Marker of Acute Myocardial Infarction

Current Atherosclerosis Reports, Jul 2014

The concentration of copeptin, the C-terminal part of pro-arginine vasopressin, has been shown to increase early after acute and severe events. Owing to complementary pathophysiology and kinetics, the unspecific marker copeptin, in combination with highly cardio-specific troponin, has been evaluated as an early-rule-out strategy for acute myocardial infarction in patients presenting with signs and symptoms of acute coronary syndrome. Overall, most studies have reported a negative predictive value between 97 and 100 % for the diagnosis of acute myocardial infarction in low- to intermediate-risk patients with suspected acute coronary syndrome. Additionally, a recent multicenter, randomized process study, where patients who tested negative for copeptin and troponin were discharged from the emergency department, showed that the safety of the new process was comparable to that of the current standard process. Further interventional trials and data from registries are needed to ensure the effectiveness and patient benefit of the new strategy.

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Copeptin—Marker of Acute Myocardial Infarction

Martin Mckel Julia Searle The concentration of copeptin, the C-terminal part of pro-arginine vasopressin, has been shown to increase early after acute and severe events. Owing to complementary pathophysiology and kinetics, the unspecific marker copeptin, in combination with highly cardio-specific troponin, has been evaluated as an early-rule-out strategy for acute myocardial infarction in patients presenting with signs and symptoms of acute coronary syndrome. Overall, most studies have reported a negative predictive value between 97 and 100 % for the diagnosis of acute myocardial infarction in low- to intermediate-risk patients with suspected acute coronary syndrome. Additionally, a recent multicenter, randomized process study, where patients who tested negative for copeptin and troponin were discharged from the emergency department, showed that the safety of the new process was comparable to that of the current standard process. Further interventional trials and data from registries are needed to ensure the effectiveness and patient benefit of the new strategy. Introduction The Clinical Need The Current Evidence The Copeptin Cutoff AMI Prevalence and Pretest Probability Time Point of Blood Sampling d f s in g lle to h om ta tin reno seon % 36 tpm lavu isex s r 5 y e re titeanp tfeah .;s91 itinhw tfsseo tsyudb tiphw tsenm fo% iti3nh topymm llredon trfeno suEC titsean m .5 w s e a A p o 5 P C 4 A % , ly % , % .9 % n e 7 o 3 D .0 n -9 .6 I .0 A 7 % lo .3 .26 98 M 99 gC .-19 .95 aT ,) 99 (98% tiepnpo .)STEN tiepnpo ) tiisenx (92% iten9p ,)snhT .-399% tiepnpo ) .5 c 9 s e lu .7 lu .9 h e u .9 n p 9 p 9 i u 99 (9 lp 9 t n s . lo T -9 T -9 w lao lp -9 % T -9 a n .8 n .6 ts 1 7 n .3 PV snTT shT (95 sh (9 ien nTT nTT .(79 .97 sh (9 a T 6 T 6 t a N h P I S 5 ec E c n - T - a s 2 leg .S leg -b a [1 isan tsudy isan rseum tsuyd .ltae ledud f e f e e r c isso ticv ed isso itcv (sam tieen Iex laayn rseop lcdux laayn rsepo tydu raph ETM b p e b p s C S , e s iv , PEOD ittaen itspo iisson iapn PTCA ioponn tilaon i-rsk I .yC Ip ted dm h tse RA trg env ihg EM ed tsud TEM tseo taa tiw cyh tfeh iran con .tH ST lud S h in ts r n d c itlrseuppuo t:ssubduy titseanpw trrfopono tiaaepdnn rcaonnoon lceeduxd lissaaynbo tscyudopm ithPTCwO aeaegnmm titseaanpn titseaenpx 8 n n le ( e a i ing % th ifc lti(saon .I148M titsaepn tifsonu lssaepm lti(aonm it)hw .I105 u E re g d u tse EM p T w in o po is T po S e w lo p 8 S N F o b 2 N R F K o re l/ R tinp rehm l/lo l/lo l/lo /llo tno gm hK e m m m say .74 itw p (T m p p p o p 0 4 8 s C 5 1 1 1 A ay PY A l PY A s R R l/ R R l/ s o a K B K B lo m n n r n r ti it e p it eh pm ep ep ish 14 ep is 4 p p F < p F 1 o o o h . g ) ih tre )0 % .4% ithw leecn ,)032 /(3823 ttieng .257 I22 s g / s I M itlanou ec iti(snno (701% .163% ,trsydu .tedAM ,)SETN p n la .5 I te r 5 ) iopn lreaev upop I64M SETM l-ecen treop /0440 /5041 s p U A N g no (1 (9 ie I P in d M C S ro ce on % 10 p n it .2 I ts lea lau 41 M te v p I E re re op M ST p Ip A N ) 5 r % 4 y /2 ten .79 I r 9 ec I M th an .) (3 it E ) l o k l M T 7 (eah /rco row .9% (um .)A SN ,96 n p t 5 n se ,) /1 ito rou ten I1 ito its 67 16 la g in M la 6 ,9 (1 u r u E u 1 /1 p te p h 6 % Study End Point Conclusion Compliance with Ethics Guidelines Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. References


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Martin Möckel, Julia Searle. Copeptin—Marker of Acute Myocardial Infarction, Current Atherosclerosis Reports, 2014, 421, DOI: 10.1007/s11883-014-0421-5