Department of Emergency Medicine, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM UMRS 956, Université Pierre et Marie Curie-Paris 6, 75013, Paris, France.
Am J Emerg Med. 2012 Mar;30(3):440-8. doi: 10.1016/j.ajem.2011.12.008.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD).
Patients with a previous history of CAD presenting in the emergency department with acute chest pain lasting for 6 hours or less suggestive of non-ST-segment elevation AMI and negative cTn were selected. Levels of copeptin were blindly measured at presentation. The diagnosis was adjudicated by 2 independent experts using all available data including cTn.
A total of 451 patients were included (mean age, 67±14; 330 [73%] men). The adjudicated final diagnosis was AMI in 36 (8%) patients, unstable angina in 131 (29%), and other diagnosis in 284 (63%). A negative cTn combined with a copeptin value lower than 10.7 pmol/L at presentation was able to rule out AMI, with a negative predictive value of 98% (95% confidence interval, 95%-99%).
In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
这项多中心研究的主要目的是评估加压素原（copeptin）对有冠心病（CAD）既往史、因急性胸痛就诊且 cTn 阴性的急性心肌梗死（AMI）患者进行快速排除的附加价值。
选择有 CAD 既往史、因急性胸痛就诊且胸痛持续时间 6 小时或更短提示非 ST 段抬高型 AMI 且 cTn 阴性的患者。于就诊时盲法检测 copeptin 水平。采用包括 cTn 在内的所有可用数据，由 2 位独立专家对诊断进行裁决。
共纳入 451 例患者（平均年龄 67±14 岁；330 例[73%]为男性）。经裁决，36 例（8%）患者的最终诊断为 AMI，131 例（29%）为不稳定型心绞痛，284 例（63%）为其他诊断。cTn 阴性且就诊时 copeptin 值低于 10.7 pmol/L 可排除 AMI，阴性预测值为 98%（95%置信区间，95%-99%）。
在因急性胸痛就诊且胸痛持续时间不足 6 小时且有 CAD 既往史的患者中，copeptin 与 cTn 的联合检测可排除 AMI，阴性预测值大于 95%。
