Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: Results from the CHOPIN trial

Nicholas A. Marston, Kevin S. Shah, Christian Mueller, Sean Xavier Neath, Robert H. Christenson, James McCord, Richard M. Nowak, Lori B. Daniels, Judd E. Hollander, Fred Apple, John Nagurney, Donald Schreiber, Christopher Defilippi, Deborah Diercks, Alexander Limkakeng, Inder S. Anand, Alan H B Wu, Allan S Jaffe, W. Frank Peacock, Alan S. Maisel

Research output: Contribution to journalArticle

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Abstract

Background: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. Methods: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. Results: Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006). Conclusions: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.

Original languageEnglish (US)
Pages (from-to)23-29
Number of pages7
JournalEmergency Medicine Journal
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2016

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Chest Pain
Troponin
Myocardial Infarction
copeptins
Acute Pain
Multicenter Studies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

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Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain : Results from the CHOPIN trial. / Marston, Nicholas A.; Shah, Kevin S.; Mueller, Christian; Neath, Sean Xavier; Christenson, Robert H.; McCord, James; Nowak, Richard M.; Daniels, Lori B.; Hollander, Judd E.; Apple, Fred; Nagurney, John; Schreiber, Donald; Defilippi, Christopher; Diercks, Deborah; Limkakeng, Alexander; Anand, Inder S.; Wu, Alan H B; Jaffe, Allan S; Peacock, W. Frank; Maisel, Alan S.

In: Emergency Medicine Journal, Vol. 33, No. 1, 01.01.2016, p. 23-29.

Research output: Contribution to journalArticle

Marston, NA, Shah, KS, Mueller, C, Neath, SX, Christenson, RH, McCord, J, Nowak, RM, Daniels, LB, Hollander, JE, Apple, F, Nagurney, J, Schreiber, D, Defilippi, C, Diercks, D, Limkakeng, A, Anand, IS, Wu, AHB, Jaffe, AS, Peacock, WF & Maisel, AS 2016, 'Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: Results from the CHOPIN trial', Emergency Medicine Journal, vol. 33, no. 1, pp. 23-29. https://doi.org/10.1136/emermed-2015-204692
Marston, Nicholas A. ; Shah, Kevin S. ; Mueller, Christian ; Neath, Sean Xavier ; Christenson, Robert H. ; McCord, James ; Nowak, Richard M. ; Daniels, Lori B. ; Hollander, Judd E. ; Apple, Fred ; Nagurney, John ; Schreiber, Donald ; Defilippi, Christopher ; Diercks, Deborah ; Limkakeng, Alexander ; Anand, Inder S. ; Wu, Alan H B ; Jaffe, Allan S ; Peacock, W. Frank ; Maisel, Alan S. / Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain : Results from the CHOPIN trial. In: Emergency Medicine Journal. 2016 ; Vol. 33, No. 1. pp. 23-29.
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abstract = "Background: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. Methods: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. Results: Of the 476 patients analysed, 365 (76.7{\%}) had a persistently elevated copeptin at 2 h and 111 patients (23.3{\%}) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9{\%}) compared with 0 (0{\%}) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100{\%} (95{\%} CI 96.7{\%} to 100{\%}). On 30-day follow-up there were 36 MACEs (9.9{\%}) in the positive second copeptin group and 2 (1.8{\%}) MACEs in the negative second copeptin group (p=0.006). Conclusions: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.",
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T1 - Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain

T2 - Results from the CHOPIN trial

AU - Marston, Nicholas A.

AU - Shah, Kevin S.

AU - Mueller, Christian

AU - Neath, Sean Xavier

AU - Christenson, Robert H.

AU - McCord, James

AU - Nowak, Richard M.

AU - Daniels, Lori B.

AU - Hollander, Judd E.

AU - Apple, Fred

AU - Nagurney, John

AU - Schreiber, Donald

AU - Defilippi, Christopher

AU - Diercks, Deborah

AU - Limkakeng, Alexander

AU - Anand, Inder S.

AU - Wu, Alan H B

AU - Jaffe, Allan S

AU - Peacock, W. Frank

AU - Maisel, Alan S.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. Methods: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. Results: Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006). Conclusions: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.

AB - Background: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear. Methods: The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects with an initial negative troponin but an elevated copeptin (>14 pmol/L) were included in this study. Copeptin and troponin levels were rechecked at 2 h and the final diagnosis of AMI was made by two independent, blinded cardiologists. Follow-up at 30 days was obtained for major adverse cardiac events (MACEs), including death, AMI and urgent revascularisation. Results: Of the 476 patients analysed, 365 (76.7%) had a persistently elevated copeptin at 2 h and 111 patients (23.3%) had a copeptin that fell below the cut-off of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006). Conclusions: Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI. A second copeptin drawn 2 h after presentation may help risk stratify and potentially rule out AMI in this cohort.

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