Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial

Marston, Nicholas; Shah, Kevin; Müeller, Christian; Neath, Sean‐Xavier; Christenson, Robert H.; McCord, James; Nowak, Richard M.; Daniels, Lori B.; Hollander, Judd E.; Apple, Fred S.; Nagurney, John T.; Schreiber, Donald; deFilippi, Christopher R.; Diercks, Deborah B.; Anand, Inder S.; Wu, Alan H.B.; Jaffe, Allan S.; Peacock, W. Frank; Maisel, Alan S.

doi:10.1136/emermed-2015-204692

Cited by 10 publications

(16 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because of the limited sensitivity of the electrocardiogram (ECG) and conventional cTn assays, the safe rule-out of AMI requires a second cTn sample and a second ECG recording 6-12 h after presentation if a conventional cTn assay is used. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] A shorter, 1 h or 3 h, protocol can be used with high sensitivity assays. 23,25,26 The delay in ruling out AMI can interfere with the detection of the underlying disease, increase patient anxiety, and is associated with substantial use of resources in the emergency department (ED), which contributes to ED crowding and its associated medical and economic harm.…”

Section: Need For Early Rule-out Of Amimentioning

confidence: 99%

Use of copeptin for rapid rule-out of acute myocardial infarction

Müeller

Möckel

Giannitsis

et al. 2017

European Heart Journal: Acute Cardiovascular Care

Self Cite

View full text Add to dashboard Cite

Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care. However, the dual-marker approach seems to provide only very small incremental value when used in combination with sensitive or high-sensitivity cardiac troponin assays. This review aims to update and educate regarding the potential and the procedural details, as well as the caveats and challenges of using copeptin in clinical practice.

show abstract

Section: Need For Early Rule-out Of Amimentioning

confidence: 99%

Use of copeptin for rapid rule-out of acute myocardial infarction

Müeller

Möckel

Giannitsis

et al. 2017

European Heart Journal: Acute Cardiovascular Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite a rise in normetanephrine across the assault exposure and evidence of a strong relationship between copeptin and osmolality, changes in cortisol, normetanephrine and osmolality did not reflect T cMax as well as copeptin and sCr. As described in the introduction, copeptin has been found to be of prognostic value in various conditions such as sepsis (Seligman et al 2008 ), septic and haemorrhagic shock (Morgenthaler et al 2007 ), in lower respiratory tract infections (Müller et al 2007 ), heart failure (Stoiser et al 2006 ) and myocardial infarction (Marston et al 2016 ). We report for the first time an initial association between increased copeptin and higher physiological strain under thermal stress.…”

Section: Discussionmentioning

confidence: 99%

“…In healthy subjects performing a high altitude trek, plasma concentrations of copeptin and AVP associated closely and the correlation was strengthened ( r = 0.834, p < 0.001) at the highest and most stressful measurement point (Mellor et al 2015 ). In disease, copeptin has been found to be of prognostic value in diverse conditions such as sepsis (Seligman et al 2008 ), septic and haemorrhagic shock (Morgenthaler et al 2007 ), lower respiratory tract infections (Müller et al 2007 ), cardio- and cerebrovascular disease (Sun et al 2015 ; Stoiser et al 2006 ; Marston et al 2016 ; Greisenegger et al 2015 ) and for end stage renal failure, coronary heart disease and all-cause mortality in patients with type 1 diabetes (Velho et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Copeptin reflects physiological strain during thermal stress

Stacey

Delves²,

Britland³

et al. 2017

Eur J Appl Physiol

View full text Add to dashboard Cite

PurposeTo prevent heat-related illnesses, guidelines recommend limiting core body temperature (T c) ≤ 38 °C during thermal stress. Copeptin, a surrogate for arginine vasopressin secretion, could provide useful information about fluid balance, thermal strain and health risks. It was hypothesised that plasma copeptin would rise with dehydration from occupational heat stress, concurrent with sympathoadrenal activation and reduced glomerular filtration, and that these changes would reflect T c responses.MethodsVolunteers (n = 15) were recruited from a British Army unit deployed to East Africa. During a simulated combat assault (3.5 h, final ambient temperature 27 °C), T c was recorded by radiotelemetry to differentiate volunteers with maximum T c > 38 °C versus ≤ 38 °C. Blood was sampled beforehand and afterwards, for measurement of copeptin, cortisol, free normetanephrine, osmolality and creatinine.ResultsThere was a significant (P < 0.05) rise in copeptin from pre- to post-assault (10.0 ± 6.3 vs. 16.7 ± 9.6 pmol L−1, P < 0.001). Although osmolality did not increase, copeptin correlated strongly with osmolality after the exposure (r = 0.70, P = 0.004). In volunteers with maximum T c > 38 °C (n = 8) vs ≤ 38 °C (n = 7) there were significantly greater elevations in copeptin (10.4 vs. 2.4 pmol L−1) and creatinine (10 vs. 2 μmol L−1), but no differences in cortisol, free normetanephrine or osmolality.ConclusionsChanges in copeptin reflected T c response more closely than sympathoadrenal markers or osmolality. Dynamic relationships with tonicity and kidney function may help to explain this finding. As a surrogate for integrated physiological strain during work in a field environment, copeptin assay could inform future measures to prevent heat-related illnesses.

show abstract

“…The limit of quantification (LoQ) was 1.23 pmol/L, and the analytical measurable range (AMR) was 500 pmol/L. Initial studies used a copeptin cut-off level of 14 pmol/L; however, recent studies have suggested that a 10 pmol/L cut-off level might be more appropriate for ruling out early AMI [1415]. Accordingly, we used a second-generation copeptin assay and 10 pmol/L as the cut-off level.…”

Section: Methodsmentioning

confidence: 99%

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

et al. 2020

View full text Add to dashboard Cite

BackgroundRapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI).MethodsWe prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed.ResultsThe patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients.ConclusionsThe combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

show abstract

Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial

Abstract: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.

Cited by 10 publications

References 17 publications

Use of copeptin for rapid rule-out of acute myocardial infarction

Use of copeptin for rapid rule-out of acute myocardial infarction

Copeptin reflects physiological strain during thermal stress

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

Contact Info

Product

Resources

About