ReviewA Systematic Review and Collaborative Meta-Analysis to Determine the Incremental Value of Copeptin for Rapid Rule-Out of Acute Myocardial Infarction
Section snippets
Methods
Prespecified inclusion and exclusion criteria were established at the outset of the study. We included any study that (1) assessed patients who presented to the emergency department with nontraumatic chest pain and (2) measured copeptin levels. We excluded any study that (1) limited patients to those only with myocardial infarction or a specific subgroup of patients, (2) excluded patients with an initial positive troponin, and (3) utilized a case-control format. We included studies regardless
Results
Of 322 citations on copeptin, we assessed 66 abstracts from which we performed detailed review of 35 full-text manuscripts. We excluded 31 abstracts because they pertained to heart failure, pulmonary embolus, or other disease states that cause chest pain but do not meet criteria for enrollment in our study. AMI was not the outcome of interest for the study. After evaluation based on prespecified inclusion and exclusion criteria, 22 articles were excluded because of the performance of the study
Discussion
The findings of this systematic review and collaborative meta-analysis demonstrate that copeptin alone has marginal diagnostic value for the assessment of AMI. However, the combination of copeptin and the initial troponin, whether conventional or high sensitivity, led to a significant improvement in sensitivity, NPV, and negative likelihood ratios. This is important for patient care because the addition of copeptin to troponin in the emergency department may not only help providers more rapidly
Disclosures
Dr. Epstein – equity holder in and consultant for GenWay Biotech, Dr. Miró – grant support from Brahms Thermofisher, Catalonian and Spanish government, consultant for Novartis, lecturer for Bayer, Dr. Giannitsis – research support from Roche Diagnostics, AstraZeneca, Mitsubishi Chemicals, Siemens Healthcare, Brahms Thermofisher consultant for Roche Diagnostics, AstraZeneca, Bayer Schering, and Brahms Thermofisher, honoraria from Roche Diagnostics, AstraZeneca, Siemens Healthcare, Mitsubishi
References (55)
- et al.
C-terminal provasopressin (copeptin) is associated with left ventricular dysfunction, remodeling, and clinical heart failure in survivors of myocardial infarction
J Card Fail
(2008) - et al.
Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis
J Clin Epidemiol
(2001) - et al.
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease
Am J Emerg Med
(2012) - et al.
Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease
Int J Cardiol
(2012) - et al.
Incremental value of copeptin for rapid rule out of acute myocardial infarction
J Am Coll Cardiol
(2009) - et al.
Comparison of the performances of cardiac troponins, including sensitive assays, and copeptin in the diagnostic of acute myocardial infarction and long-term prognosis between women and men
Am Heart J
(2013) - et al.
Copeptin for rapid rule out of acute myocardial infarction in emergency department
Int J Cardiol
(2013) - et al.
High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain
Clin Chim Acta
(2012) - et al.
Diagnostic role of copeptin in patients presenting with chest pain in the emergency room
Eur J Intern Med
(2013) - et al.
Copeptin improves early diagnosis of acute myocardial infarction
J Am Coll Cardiol
(2010)
Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin helps in the early detection of patients with acute myocardial infarction)
J Am Coll Cardiol
Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: a pilot study
Arch Cardiovasc Dis
Early rule out of acute myocardial infarction in ED patients: value of combined high-sensitivity cardiac troponin T and ultrasensitive copeptin assays at admission
Am J Emerg Med
Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay
J Am Coll Cardiol
Heart disease and stroke statistics–2013 update: a report from the American Heart Association
Circulation
Structure-function relationships of the vasopressin prohormone domains
Cell Mol Neurobiol
Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma
J Clin Invest
A glycopeptide from the posterior lobe of pig pituitaries. I. Isolation and characterization
Eur J Biochem
Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin
Clin Chem
The utility of copeptin in the emergency department as a predictor of adverse outcomes in non-ST-elevation acute coronary syndrome: the COPED-PAO study
Emerg Med J
C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) study
Circulation
Association of copeptin with myocardial infarct size and myocardial function after ST segment elevation myocardial infarction
Heart
Association of copeptin and N-terminal proBNP concentrations with risk of cardiovascular death in older patients with symptoms of heart failure
JAMA
Increased 90-day mortality in patients with acute heart failure with elevated copeptin: secondary results from the Biomarkers in Acute Heart Failure (BACH) study
Circ Heart Fail
Copeptin, a stable peptide of the arginine vasopressin precursor, is elevated in hemorrhagic and septic shock
Shock
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group
JAMA
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Ann Intern Med
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