A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction

TY - JOUR

T1 - A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction

AU - Lipinski, Michael J

AU - Escárcega, Ricardo O

AU - D'Ascenzo, Fabrizio

AU - Magalhães, Marco A

AU - Baker, Nevin C

AU - Torguson, Rebecca

AU - Chen, Fang

AU - Epstein, Stephen E

AU - Miró, Oscar

AU - Llorens, Pere

AU - Giannitsis, Evangelos

AU - Lotze, Ulrich

AU - Lefebvre, Sophie

AU - Sebbane, Mustapha

AU - Cristol, Jean-Paul

AU - Chenevier-Gobeaux, Camille

AU - Meune, Christophe

AU - Eggers, Kai M

AU - Charpentier, Sandrine

AU - Twerenbold, Raphael

AU - Mueller, Christian

AU - Biondi-Zoccai, Giuseppe

AU - Waksman, Ron

N1 - Copyright © 2014 Elsevier Inc. All rights reserved.

PY - 2014/5/1

Y1 - 2014/5/1

N2 - Multiple studies have evaluated copeptin, a surrogate for arginine vasopressin, in the diagnosis of acute myocardial infarction (AMI) with mixed results. A systematic review and collaborative meta-analysis were performed for diagnosis of AMI and assessment of prognosis in patients presenting to the emergency department with chest pain. MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing copeptin in such patients. Study investigators were contacted, and many provided previously unpublished data. Random-effects methods were used to compare the data for copeptin, troponin, and their combination. There were a total of 9,244 patients from the 14 included studies. Mean age was 62 years; 64% were men; and 18.4% were ultimately diagnosed with AMI. Patients with AMI had a higher presentation copeptin level than those without AMI (22.8 vs 8.3 pmol/L, respectively, p <0.001). Although troponin had better diagnostic accuracy than copeptin for AMI, the combination of copeptin and troponin significantly improved the sensitivity (0.905 [0.888 to 0.921] vs 0.686 [0.661 to 0.710], respectively, p <0.001) and negative predictive value (0.97 [0.964 to 0.975] vs 0.93 [0.924 to 0.936], respectively, p <0.001) compared with troponin alone. Elevation in copeptin carried a similar risk of all-cause mortality to an elevation in troponin (odds ratio 5.84 vs 6.74, respectively, p = 0.67). In conclusion, copeptin not only identifies patients at risk of all-cause mortality, but its addition to troponin improved the sensitivity and negative likelihood ratio for diagnosis of AMI compared with troponin alone. Thus, copeptin may help identify patients who may be safely discharged early from the emergency department.

AB - Multiple studies have evaluated copeptin, a surrogate for arginine vasopressin, in the diagnosis of acute myocardial infarction (AMI) with mixed results. A systematic review and collaborative meta-analysis were performed for diagnosis of AMI and assessment of prognosis in patients presenting to the emergency department with chest pain. MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing copeptin in such patients. Study investigators were contacted, and many provided previously unpublished data. Random-effects methods were used to compare the data for copeptin, troponin, and their combination. There were a total of 9,244 patients from the 14 included studies. Mean age was 62 years; 64% were men; and 18.4% were ultimately diagnosed with AMI. Patients with AMI had a higher presentation copeptin level than those without AMI (22.8 vs 8.3 pmol/L, respectively, p <0.001). Although troponin had better diagnostic accuracy than copeptin for AMI, the combination of copeptin and troponin significantly improved the sensitivity (0.905 [0.888 to 0.921] vs 0.686 [0.661 to 0.710], respectively, p <0.001) and negative predictive value (0.97 [0.964 to 0.975] vs 0.93 [0.924 to 0.936], respectively, p <0.001) compared with troponin alone. Elevation in copeptin carried a similar risk of all-cause mortality to an elevation in troponin (odds ratio 5.84 vs 6.74, respectively, p = 0.67). In conclusion, copeptin not only identifies patients at risk of all-cause mortality, but its addition to troponin improved the sensitivity and negative likelihood ratio for diagnosis of AMI compared with troponin alone. Thus, copeptin may help identify patients who may be safely discharged early from the emergency department.

KW - Biomarkers/analysis

KW - Female

KW - Glycopeptides/physiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/diagnosis

U2 - 10.1016/j.amjcard.2014.01.436

DO - 10.1016/j.amjcard.2014.01.436

M3 - SCORING: Review article

C2 - 24731654

VL - 113

SP - 1581

EP - 1591

JO - AM J CARDIOL

JF - AM J CARDIOL

SN - 0002-9149

IS - 9

ER -