Abstract 5021: Copeptin Improves Early Diagnosis of Acute Myocardial Infarction

Introduction: Early diagnosisof myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation. Background: Aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to conventional troponin in early evaluation of patients with suspected myocardial infarction. Methods: Between 06/2006 and 03/2008 patients with suspected acute coronary syndrome were enrolled consecutively. Copeptin, troponin T, myoglobin and creatine kinase-MB were determined at admission and after 3 and 6 hours. Results: Of 1293 (66.1% male) enrolled patients 244 (18.9%) had the discharge diagnosis of acute myocardial infarction, 211 (16.3%) presented with unstable angina and in 838 (64.8%) patients an acute coronary syndrome could be excluded. Combined measurement of copeptin and troponin T at admission improved the c-statistic from 0.85 for troponin T alone to 0.94 in the overall population and from 0.77 to 0.91 in patients presenting within 3 hours after chest pain onset. In this group the combination provided an excellent negative predictive value of 91.1%. Conclusions: In triage of chest pain patients determination of copeptin in addition to conventional troponin T improves diagnostic performance, especially early after chest pain onset. Combined determination of troponin T and copeptin provides an excellent negative predictive value virtually independent of chest pain onset time and therefore allows an early and safe rule-out of myocardial infarction.