Copeptin Tests May Be Used to Rule Out Acute Coronary Syndrome

Negative copeptin and troponin tests may be used to rule out an acute myocardial infarction…. 

Biomarkers in Cardiology 8 (BiC-8) is a recent study integrating copeptin with troponin tests in order to rule out an acute myocardial infarction. Copeptin, a stable peptide of the arginine vasopressin precursor, is detectable in patients with acute MI 0-4 hours after onset of symptoms and starts decreasing after 5 hours.

Nine hundred two (902) patients at risk of an acute coronary syndrome and with negative troponin values were randomized into an experimental arm with copeptin assay or to standard of care consisting of a series of troponin testings. Positive copeptin tests were defined as >10 pmol/L values, and these patients were treated with standard ACS care. Negative tests were < 10 pmol/L and patients were discharged from the hospital then scheduled for a follow up within 72 hours.

At 30 days, the rate of major adverse cardiovascular events was 5.46% in the experimental arm and 5.5% in the standard care arm, a difference that was not statistically significant. Discharge rate was 66% in the experimental group and 12% in the standard care group.

Practice Pearls:

• Negative copeptin tests may rule out ACS.
• Rates of major adverse cardiovascular events were not statistically significant between early discharge and standard of care groups.
• Patients who test negative for troponin and copeptin may be safely discharged from the hospital.

European Society of Cardiology Congress, September 2013