Diagnostic role of copeptin in patients presenting with chest pain in the emergency room

Christian Folli, Dario Consonni, Marzia Spessot, Laura Salvini, Marta Velati, Guido Ranzani, Rita Maiavacca, Valter Monzani

Research output: Contribution to journalArticle

Abstract

Background: Chest pain is a frequent symptom leading patients to the Emergency Room. Copeptin, the C-terminal fragment of arginin-vasopressin, is a marker of stressful situations. Recent studies showed that normal levels of copeptin combined with normal troponin accurately rule out the diagnosis of acute coronary syndrome (ACS). In this observational, prospective, multicenter study we evaluated if negative levels of copeptin combined with negative troponin (Tn-T) can correctly rule out the diagnosis of ACS and also of other life-threatening causes of chest pain. Results: Of 472 enrolled patients (64.6% males, mean age 60.1 yrs), 28 (5.9%) were diagnosed with ST-elevation myocardial infarction (STEMI), 28 (5.9%) with non ST-elevation myocardial infarction (NSTEMI), 43 (9.1%) with unstable angina (UA), 13 (2.8%) with potentially life-threatening non-ACS pathologies (aortic dissection, pulmonary embolism, pulmonary edema, sepsis), 360 (76.2%) with benign causes of chest pain. Copeptin levels were significantly higher in ACS patients with STEMI and NSTEMI than in those with other diagnoses, but not in those with UA. The combination of copeptin and troponin-T attained a negative predictive value of 86.6% for ACS, of 97.9% for other potentially life-threatening non-ACS diseases and of 85% for all potentially lethal diseases (ACS plus others). Conclusions: The combined use of troponin and copeptin significantly improved the diagnostic accuracy of troponin alone both in ACS (STEMI and NSTEMI) and in other life-threatening diseases. Measurement of this marker might be therefore considered not only for a rule-out strategy but also as a warning sign of a life-threatening disease.

Original languageEnglish
Pages (from-to)189-193
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume24
Issue number2
DOIs
Publication statusPublished - Mar 2013

Fingerprint

Acute Coronary Syndrome
Chest Pain
Hospital Emergency Service
Troponin
Troponin T
Unstable Angina
Pulmonary Edema
Vasopressins
Pulmonary Embolism
Multicenter Studies
Coronary Disease
copeptins
Dissection
Sepsis
Prospective Studies
Pathology
ST Elevation Myocardial Infarction
Non-ST Elevated Myocardial Infarction

Keywords

  • Acute coronary syndrome
  • Chest pain
  • Copeptin
  • Life-threatening diseases

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Diagnostic role of copeptin in patients presenting with chest pain in the emergency room. / Folli, Christian; Consonni, Dario; Spessot, Marzia; Salvini, Laura; Velati, Marta; Ranzani, Guido; Maiavacca, Rita; Monzani, Valter.

In: European Journal of Internal Medicine, Vol. 24, No. 2, 03.2013, p. 189-193.

Research output: Contribution to journalArticle

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abstract = "Background: Chest pain is a frequent symptom leading patients to the Emergency Room. Copeptin, the C-terminal fragment of arginin-vasopressin, is a marker of stressful situations. Recent studies showed that normal levels of copeptin combined with normal troponin accurately rule out the diagnosis of acute coronary syndrome (ACS). In this observational, prospective, multicenter study we evaluated if negative levels of copeptin combined with negative troponin (Tn-T) can correctly rule out the diagnosis of ACS and also of other life-threatening causes of chest pain. Results: Of 472 enrolled patients (64.6{\%} males, mean age 60.1 yrs), 28 (5.9{\%}) were diagnosed with ST-elevation myocardial infarction (STEMI), 28 (5.9{\%}) with non ST-elevation myocardial infarction (NSTEMI), 43 (9.1{\%}) with unstable angina (UA), 13 (2.8{\%}) with potentially life-threatening non-ACS pathologies (aortic dissection, pulmonary embolism, pulmonary edema, sepsis), 360 (76.2{\%}) with benign causes of chest pain. Copeptin levels were significantly higher in ACS patients with STEMI and NSTEMI than in those with other diagnoses, but not in those with UA. The combination of copeptin and troponin-T attained a negative predictive value of 86.6{\%} for ACS, of 97.9{\%} for other potentially life-threatening non-ACS diseases and of 85{\%} for all potentially lethal diseases (ACS plus others). Conclusions: The combined use of troponin and copeptin significantly improved the diagnostic accuracy of troponin alone both in ACS (STEMI and NSTEMI) and in other life-threatening diseases. Measurement of this marker might be therefore considered not only for a rule-out strategy but also as a warning sign of a life-threatening disease.",
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