Citation: American Journal of Cardiology. 113(9):1581-91, 2014 May 1..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Lipinski MJ; Escarcega RO; D'Ascenzo F; Magalhaes MA; Baker NC; Torguson R; Chen F; Epstein SE; Miro O; Llorens P; Giannitsis E; Lotze U; Lefebvre S; Sebbane M; Cristol JP; Chenevier-Gobeaux C; Meune C; Eggers KM; Charpentier S; Twerenbold R; Mueller C; Biondi-Zoccai G; Waksman R.UI/PMID: 24731654.Subject(s): Biological Markers/an [Analysis] | Female | *Glycopeptides/ph [Physiology] | Humans | Male | Middle Aged | *Myocardial Infarction/di [Diagnosis]Institution(s): MedStar Heart & Vascular Institute | MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Meta-Analysis | ReviewOnline resources: Click here to access onlineDigital Object Identifier: http://dx.doi.org/10.1016/j.amjcard.2014.01.436 (Click here)Abbreviated citation: Am J Cardiol. 113(9):1581-91, 2014 May 1.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: 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 Study investigators were contacted, and many provided previously unpublished data.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. Copyright 2014 Elsevier Inc. All rights reserved.