The prognostic value of copeptin in patients with acute chest pain

Abstract

The prognostic value of copeptin in acute chest pain is an area of rapid growth and research interest. Copeptin has already established a role in early diagnosis and rule out of acute myocardial infarction, but as its use increases much of the attention has been directed at the prognostic value of copeptin. This article reviews the growing body of evidence supporting the use of copeptin to further risk-stratify chest pain patients. The studies included address a variety of populations ranging from all patients presenting with chest pain to those who are at high risk, diagnosed with acute coronary syndrome or found to have left ventricular dysfunction. Many of the studies compare and combine the prognostic value of copeptin with other prognostic markers such as troponin, brain natriuretic peptide and Global Registry of Acute Coronary Events scores. Caveats of copeptin are also discussed such as gender differences, cutoff points and the importance of timing in the copeptin assay.

Keywords::

• acute coronary syndrome
• acute myocardial infarction
• chest pain
• chest pain rule out
• copeptin
• MACE
• mortality
• NSTEMI
• prognosis
• STEMI

Financial & competing interests disclosure

NA Marston has received travel support from Brahms-Thermofisher. AS Maisel has received research support from BG Medical, Abbott, Alere, Brahms-Thermofisher; Consulting: BG Med, Alere; Speaking: Alere, BG Med. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Multiple studies have demonstrated copeptin’s additive role in early acute myocardial infarction diagnosis and rule out.

• In addition to diagnostic value, copeptin has been shown to have prognostic value for chest pain patients with and without acute coronary syndrome.

• Copeptin has predictive value in non-ST-elevation myocardial infarction and ST-elevation myocardial infarction patients with LV dysfunction.

• Copeptin has prognostic value in patients with coronary artery disease, men and women and non-acute coronary syndromes etiologies of chest pain.

• The predictive value of copeptin has been demonstrated as early as that hospital stay and as far out as 33 months.

• Copeptin is an independent predictor of poor outcomes and has additive value to established prognostic indicators such as troponin, brain natriuretic peptide and Global Registry of Acute Coronary Events score.

• The prognostic value of copeptin appears to be incremental, with higher levels associated with higher event rates.

Notes