• Jonathan Duchenne, Stéphanie Mestres, Nicolas Dublanchet, Nicolas Combaret, Geoffroy Marceau, Laurent Caumon, Laurent Dutoit, Sylvie Ughetto, Pascal Motreff, Vincent Sapin, Jeannot Schmidt, and NSTEMI Study.
• Emergency Department, Henri Mondor Hospital, Aurillac, France. j.duchenne@ch-aurillac.fr
• BMJ Open. 2014 Mar 24; 4 (3): e004449.

ObjectiveTo determine whether copeptin-us can rule out diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) without prolonged monitoring and serial blood sampling in patients with high-sensitive cardiac troponin I (hs-cTnI) below the 99th centile at presentation to the emergency department (ED) [corrected].DesignProspective, non-randomised, individual blinded diagnostic accuracy study.SettingTwo EDs of a rural region of France.ParticipantsPatients with chest pain suspected of NSTEMI with onset within the last 12 h were considered for enrollment.InterventionsSerial clinical, electrographical and biochemical investigations were performed at admission and after 2, 4, 6 and 12 h. Hs-cTnI was measured using an assay with Dimension VISTA, Siemens [corrected]. Copeptin was measured by the BRAHMS copeptin-us assay on the KRYPTOR Compact Plus system. The follow-up period was 90 days.Primary And Secondary Outcome MeasuresCopeptin, troponin, myoglobin and creatine kinase values. Clinical and paraclinical events. The final diagnosis was adjudicated blinded to copeptin result.ResultsDuring 12 months, 102 patients were analysed. Final diagnosis was NSTEMI for 7.8% (n=8), unstable angina for 3.9% (n=4), cardiac but non-coronary artery disease for 8.8% (n=9), non-cardiac chest pain for 52% (n=53) and unknown for 27.5% (n=28). There was no statistical difference for copeptin values between patients with NSTEMI and others (respectively 5.5 pmol/L IQR (3.1-7.9) and 6.5 pmol/L IQR (3.9-12.1), p=0.49). Only one patient with NSTEMI had a copeptin value above the cut-off of 95th centile at admission.ConclusionsIn this study, copeptin does not add a diagnostic value at admission to ED for patients with suspected acute coronary syndrome without ST-segment elevation and with hs-cTnI below the 99th centile [corrected].Trial Registration NumberClinicaltrials.gov identifier: NCT01334645.

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