- 作者：Alan Maisel ; Christian Mueller ; Sean-Xavier Neath ; Robert H. Christenson ; Nils G. Morgenthaler ; James McCord ; Richard M. Nowak ; Gary Vilke ; Lori B. Daniels ; Judd E. Holl ; er ; Fred S. Apple ; Chad Cannon ; John T. Nagurney ; Donald Schreiber ; Christopher deFilippi ; Christopher Hogan ; Deborah B. Diercks ; John C. Stein ; Gary Headden ; Alex ; er T. Limkakeng Jr. ; et al.
- 关键词：copeptin ; emergency department ; myocardial infarction ; quality improvement ; troponin
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：9 July, 2013
- 年：2013
- 卷：62
- 期：2
- 页码：150-160
- 全文大小：1042 K
Objectives
The goal of this study was to demonstrate that copeptin levels?<14 pmol/L allow ruling out acute myocardial infarction (AMI) when used in combination with cardiac troponin I (cTnI)?<99th percentile and a nondiagnostic electrocardiogram at the time of presentation to the emergency department (ED).Background
Copeptin is secreted from the pituitary early in the course of AMI.
Methods
This was a 16-site study in 1,967 patients with chest pain presenting to an ED within 6 hours of pain onset. Baseline demographic characteristics and clinical data were collected prospectively. Copeptin levels and a contemporary sensitive cTnI (99th percentile 40 ng/l; 10 % coefficient of variation 0.03 ¦Ìg/l) were measured in a core laboratory. Patients were followed up for 180 days. The primary outcome was diagnosis of AMI. Final diagnoses were adjudicated by 2 independent cardiologists blinded to copeptin results.
Results
AMI was the final diagnosis in 156 patients (7.9 % ). A negative copeptin and cTnI at baseline ruled out AMI for 58 % of patients, with a negative predictive value of 99.2 % (95 % confidence interval: 98.5 to 99.6). AMIs not detected by the initial cTnI alone were picked up with copeptin >14 pmol/l in 23 (72 % ) of 32 patients. Non-ST-segment elevation myocardial infarctions undetected by cTnI at 0 h were detected with copeptin >14 pmol/l in 10 (53 % ) of 19 patients. Projected average time-to-decision could be reduced by 43 % (from 3.0 h to 1.8 h) by the early rule out of 58 % of patients. Both abnormal copeptin and cTnI were predictors of death at 180 days (p?< 0.0001 for both; c?index 0.784 and 0.800, respectively). Both were independent of age and each other and provided additional predictive value (all p?< 0.0001).
Conclusions
Adding copeptin to cTnI allowed safe rule out of AMI with a negative predictive value >99 % in patients presenting with suspected acute coronary syndromes. This combination has the potential to rule out AMI in 58 % of patients without serial blood draws. (Investigation of the Biomarker Copeptin in Patients With Acute Myocardial Infarction [])