Acute Coronary Syndromes
Conditions
Keywords
acute myocardial infarction, ST-segment elevation myocardial infarction, STEMI, non-ST-segment elevation myocardial infarction, NSTEMI, unstable angina, unstable angina pectoris, UA, UAP
Brief summary
While troponin is not detectable until several hours after an Acute Myocardial Infarction (AMI), copeptin is expected to be elevated very early after an AMI. A combination of both markers for the diagnosis of AMI early after the event is therefore expected to be advantageous.
Detailed description
In patients with symptoms suggestive of acute coronary syndrome (ACS) such as chest pain or pressure, shortness of breath, diaphoresis, and nausea, detection of a rise and/or fall of troponin with at least one value above the 99th percentile of the upper reference limit is essential to the diagnosis of acute myocardial infarction (AMI). However, current troponin testing has limitations, including antibody specificity, assay imprecision, lack of standardization and a relatively late increase in the circulating troponin level after the onset of ischemia. Studies have shown a low diagnostic sensitivity of troponins when measured early (\<6 hours) after symptom onset. Although there are some more sensitive troponin assays with a coefficient of variation (CV)10% at the 99th percentile of a normal reference population, most troponin assays have an imprecision CV of around 20% at the 99th percentile of the reference population. The early insensitivity of troponin results in an unmet need in the clinical evaluation of patients presenting with suspected ACS and AMI. Copeptin may improve early AMI diagnostic sensitivity because of a number of unique characteristics. * Copeptin levels are elevated at presentation in patients with AMI compared to patients with other presentations. * Copeptin levels are elevated in patients with AMI even when troponin levels were not elevated at the time of initial presentation. * Thus, a combination of troponin and copeptin levels at presentation may result in a more accurate diagnosis of acute AMI than troponin alone. * Copeptin levels drop 1 day after an AMI.
Interventions
None listed
Sponsors
Brahms AG
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* The subject must be 18 years of age or older. * The subject must present to the Emergency Department with symptoms consistent with acute coronary syndromes (e.g., chest discomfort/pain, squeezing/fullness in the chest, pain radiating to left or both arms, jaw pain, pain in the back/neck/stomach, shortness of breath, cold sweat, nausea/vomiting, lightheadedness). * The subject must present to the Emergency Department within 6 hours of the onset of the most recent symptoms that prompted the subject to seek medical attention in the Emergency Department. * The patient agrees to abide by all aspects of the protocol, including all telephone follow-up.
Exclusion criteria
* The patient is unable to provide consent or understand the consent form. * The ACS symptoms are clearly not the result of ACS (i.e., penetrating wounds, crush injury, etc.)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Copeptin improves early diagnostic performance for AMI when used in combination with troponin for the initial blood draw in patients presenting to the emergency department with symptoms consistent with acute coronary syndromes. | at initial presentation, at 2 hours, at 6 hours |
Secondary
| Measure | Time frame |
|---|---|
| Copeptin improves AMI diag and is prog for outcome. Risk MACE > for 4th qrt. of MR-proADM than 1st. Copeptin adds to phys. assessment for AMI diag. Copeptin >18 pmol/l distinguishes between AMI and UA or other. Copeptin < 18 pmol/l excludes NSTEMI. | within 180 days after enrollment |
Countries
United States
Outcome results
None listed