Copeptin and the Early Rule-out of Acute Myocardial Infarction (AMI)

Copeptin can be used for the early rule-out of AMI in patients presenting with chest pain.

What is Copeptin?

Copeptin, is a 39-amino acid glycopeptide.  It is the C-terminal part of the prohormone of arginine vasopressin (AVP) or antidiuretic hormone (ADH).  Copeptin is released together with AVP in equimolar amounts.

AVP is unstable and the measurement of AVP is therefore prone to pre-analytical errors.  However, copeptin constitutes a stable surrogate marker for this hormone in the human body.

The clinical use of Copeptin in chest pain diagnosis

Copeptin can be used for the early rule-out of acute myocardial infarction (AMI) in patients presenting with chest pain in the emergency unit (ED).

In the setting of an AMI, copeptin is secreted rapidly after the onset of symptoms and decrease gradually reaching plateau phase on the 3rd – 5th day.  Several studies reported elevated copeptin values at the time of hospital admission with the highest concentration observed within the first 4 hours after chest pain onset.

Combining the measurement of markers copeptin and troponin (Tn) allows for a safe and rapid rule-out of AMI at presentation on admission in the ED with the first blood draw.  This is proven to safely increase ED discharge, and significantly decrease hospital and emergency unit lengths-of-stay, in patients presenting with signs and symptoms of Acute Coronary Syndrome (ACS).

When patients present in the ED with chest pain and a suspected ACS, only about 10 % of the diagnoses in these patients actually reveal myocardial infarctions.  Fast, accurate AMI rule-out help to better target monitor and improve intervention in these patients that truly having AMI.

In addition, it means:

  • Avoiding unnecessary monitoring, treatment, waits for discharge, and anxiety in the other about 90% of chest pain patients without AMI.
  • Optimizing resource allocation and processes at hospital level.
  • Optimizing patient management in the ED.
  • Improving patient risk stratification.

For more information on the clinical use of Copeptin in AMI, please download the information brochure here.