The utility of copeptin in the emergency department for non-ST-elevation myocardial infarction rapid rule out

COPED-MIRRO study

Abstract

Objective 

To evaluate whether the addition of copeptin measurement to the first troponin determination allows non-ST-elevation acute myocardial infarction to be ruled out in patients consulting the emergency department (ED) for nontraumatic chest pain (NTCP) suggestive of acute coronary syndrome (ACS) whose first electrocardiogram and troponin determination are nondiagnostic, thereby avoiding a second determination of troponin and shortening ED stay.

Methods 

We carried out a multicentric, prospective, observational, longitudinal, cohort study. Copeptin and troponin determination was performed on arrival of the patient to the ED. We selected consecutive patients with NTCP of less than 12 h of evolution suggestive of ACS with nondiagnostic electrocardiogram and normal troponin values on arrival to the ED. A second troponin determination was performed at 6 h. The negative predictive values and the global discriminative capacity of copeptin were calculated.

Results 

We studied 1018 patients (66.4±14.9 years, 62.8% men), 107 (10.5%) having non-ST-elevation acute myocardial infarction. The negative predictive value of copeptin was 94.2% and was significantly greater in patients older than 70 years of age (95.1 vs. 92.6%; P<0.05), without diabetes mellitus (95.4 vs. 90.4%; P=0.01) and arriving at the ED 6 h after the onset of NTCP (97.8 vs. 93.9%; P<0.01). The area under the copeptin receiver operating characteristic curve was 0.71 (95% confidence interval: 0.65–0.76; P<0.001).

Conclusion 

The determination of copeptin on arrival to the ED in patients with NTCP suggestive of ACS, in addition to routine troponin determination, does not allow the presence of myocardial infarction to be ruled out quickly and safely and does not avoid ED stay for a second determination of troponin.