Copeptin helps in the early detection of patients with acute myocardial infarction: Primary results of the CHOPIN trial (Copeptin Helps in the early detection of Patients with acute myocardial INfarction)

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. Hollander, Fred S. Apple, Chad Cannon, John T. Nagurney, Donald Schreiber, Christopher Defilippi, Christopher Hogan, Deborah B. Diercks, John C. Stein, Gary Headden, Alexander T. LimkakengInder Anand, Alan H B Wu, Jana Papassotiriou, Oliver Hartmann, Stefan Ebmeyer, Paul Clopton, Allan S. Jaffe, W. Frank Peacock

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

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 μg/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 [NCT00952744]).

Original languageEnglish (US)
Pages (from-to)150-160
Number of pages11
JournalJournal of the American College of Cardiology
Volume62
Issue number2
DOIs
StatePublished - Jul 9 2013

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Myocardial Infarction
Acute Coronary Syndrome
copeptins
Biomarkers

Keywords

  • copeptin
  • emergency department
  • myocardial infarction
  • quality improvement
  • troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Copeptin helps in the early detection of patients with acute myocardial infarction : Primary results of the CHOPIN trial (Copeptin Helps in the early detection of Patients with acute myocardial INfarction). / Maisel, Alan; Mueller, Christian; Neath, Sean Xavier; Christenson, Robert H.; Morgenthaler, Nils G.; McCord, James; Nowak, Richard M.; Vilke, Gary; Daniels, Lori B.; Hollander, Judd E.; Apple, Fred S.; Cannon, Chad; Nagurney, John T.; Schreiber, Donald; Defilippi, Christopher; Hogan, Christopher; Diercks, Deborah B.; Stein, John C.; Headden, Gary; Limkakeng, Alexander T.; Anand, Inder; Wu, Alan H B; Papassotiriou, Jana; Hartmann, Oliver; Ebmeyer, Stefan; Clopton, Paul; Jaffe, Allan S.; Peacock, W. Frank.

In: Journal of the American College of Cardiology, Vol. 62, No. 2, 09.07.2013, p. 150-160.

Research output: Contribution to journalArticle

Maisel, A, Mueller, C, Neath, SX, Christenson, RH, Morgenthaler, NG, McCord, J, Nowak, RM, Vilke, G, Daniels, LB, Hollander, JE, Apple, FS, Cannon, C, Nagurney, JT, Schreiber, D, Defilippi, C, Hogan, C, Diercks, DB, Stein, JC, Headden, G, Limkakeng, AT, Anand, I, Wu, AHB, Papassotiriou, J, Hartmann, O, Ebmeyer, S, Clopton, P, Jaffe, AS & Peacock, WF 2013, 'Copeptin helps in the early detection of patients with acute myocardial infarction: Primary results of the CHOPIN trial (Copeptin Helps in the early detection of Patients with acute myocardial INfarction)', Journal of the American College of Cardiology, vol. 62, no. 2, pp. 150-160. https://doi.org/10.1016/j.jacc.2013.04.011
Maisel, Alan ; Mueller, Christian ; Neath, Sean Xavier ; Christenson, Robert H. ; Morgenthaler, Nils G. ; McCord, James ; Nowak, Richard M. ; Vilke, Gary ; Daniels, Lori B. ; Hollander, Judd E. ; Apple, Fred S. ; Cannon, Chad ; Nagurney, John T. ; Schreiber, Donald ; Defilippi, Christopher ; Hogan, Christopher ; Diercks, Deborah B. ; Stein, John C. ; Headden, Gary ; Limkakeng, Alexander T. ; Anand, Inder ; Wu, Alan H B ; Papassotiriou, Jana ; Hartmann, Oliver ; Ebmeyer, Stefan ; Clopton, Paul ; Jaffe, Allan S. ; Peacock, W. Frank. / Copeptin helps in the early detection of patients with acute myocardial infarction : Primary results of the CHOPIN trial (Copeptin Helps in the early detection of Patients with acute myocardial INfarction). In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 2. pp. 150-160.
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abstract = "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 μg/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 [NCT00952744]).",
keywords = "copeptin, emergency department, myocardial infarction, quality improvement, troponin",
author = "Alan Maisel and Christian Mueller and Neath, {Sean Xavier} and Christenson, {Robert H.} and Morgenthaler, {Nils G.} and James McCord and Nowak, {Richard M.} and Gary Vilke and Daniels, {Lori B.} and Hollander, {Judd E.} and Apple, {Fred S.} and Chad Cannon and Nagurney, {John T.} and Donald Schreiber and Christopher Defilippi and Christopher Hogan and Diercks, {Deborah B.} and Stein, {John C.} and Gary Headden and Limkakeng, {Alexander T.} and Inder Anand and Wu, {Alan H B} and Jana Papassotiriou and Oliver Hartmann and Stefan Ebmeyer and Paul Clopton and Jaffe, {Allan S.} and Peacock, {W. Frank}",
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language = "English (US)",
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pages = "150--160",
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TY - JOUR

T1 - Copeptin helps in the early detection of patients with acute myocardial infarction

T2 - Primary results of the CHOPIN trial (Copeptin Helps in the early detection of Patients with acute myocardial INfarction)

AU - Maisel, Alan

AU - Mueller, Christian

AU - Neath, Sean Xavier

AU - Christenson, Robert H.

AU - Morgenthaler, Nils G.

AU - McCord, James

AU - Nowak, Richard M.

AU - Vilke, Gary

AU - Daniels, Lori B.

AU - Hollander, Judd E.

AU - Apple, Fred S.

AU - Cannon, Chad

AU - Nagurney, John T.

AU - Schreiber, Donald

AU - Defilippi, Christopher

AU - Hogan, Christopher

AU - Diercks, Deborah B.

AU - Stein, John C.

AU - Headden, Gary

AU - Limkakeng, Alexander T.

AU - Anand, Inder

AU - Wu, Alan H B

AU - Papassotiriou, Jana

AU - Hartmann, Oliver

AU - Ebmeyer, Stefan

AU - Clopton, Paul

AU - Jaffe, Allan S.

AU - Peacock, W. Frank

PY - 2013/7/9

Y1 - 2013/7/9

N2 - 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 μg/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 [NCT00952744]).

AB - 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 μg/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 [NCT00952744]).

KW - copeptin

KW - emergency department

KW - myocardial infarction

KW - quality improvement

KW - troponin

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