Multiple studies have evaluated copeptin, a surrogate for arginine vasopressin, in
the diagnosis of acute myocardial infarction (AMI) with mixed results. A systematic
review and collaborative meta-analysis were performed for diagnosis of AMI and assessment
of prognosis in patients presenting to the emergency department with chest pain. MEDLINE/PubMed,
Cochrane CENTRAL, and EMBASE were searched for studies assessing copeptin in such
patients. Study investigators were contacted, and many provided previously unpublished
data. Random-effects methods were used to compare the data for copeptin, troponin,
and their combination. There were a total of 9,244 patients from the 14 included studies.
Mean age was 62 years; 64% were men; and 18.4% were ultimately diagnosed with AMI.
Patients with AMI had a higher presentation copeptin level than those without AMI
(22.8 vs 8.3 pmol/L, respectively, p <0.001). Although troponin had better diagnostic
accuracy than copeptin for AMI, the combination of copeptin and troponin significantly
improved the sensitivity (0.905 [0.888 to 0.921] vs 0.686 [0.661 to 0.710], respectively,
p <0.001) and negative predictive value (0.97 [0.964 to 0.975] vs 0.93 [0.924 to 0.936],
respectively, p <0.001) compared with troponin alone. Elevation in copeptin carried
a similar risk of all-cause mortality to an elevation in troponin (odds ratio 5.84
vs 6.74, respectively, p = 0.67). In conclusion, copeptin not only identifies patients
at risk of all-cause mortality, but its addition to troponin improved the sensitivity
and negative likelihood ratio for diagnosis of AMI compared with troponin alone. Thus,
copeptin may help identify patients who may be safely discharged early from the emergency
department.
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Article info
Publication history
Published online: February 18, 2014
Accepted:
January 20,
2014
Received in revised form:
January 20,
2014
Received:
November 26,
2013
Footnotes
See page 1589 for disclosure information.
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Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
