What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=487). Intervention: Copeptin combined with troponin T vs. Troponin T alone. Primary outcome: Area under the receiver-operating characteristic curve for diagnosis of acute myocardial infarction (95% CI 0.95 to 0.98, p=<0.001).

What question did this study set out to answer?

To determine whether combining copeptin with conventional cardiac troponin provides incremental diagnostic accuracy for the rapid rule-out of acute myocardial infarction upon emergency presentation.

September 16, 2026Journal of the American College of Cardiology

Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction

Q: What are the key findings of this study?

Combining copeptin and troponin T at presentation yielded a significantly higher diagnostic accuracy for acute myocardial infarction than troponin T alone (AUC 0.97 vs 0.86, p<0.001).

Q: What does this research mean for the field?

Combining copeptin with troponin T at presentation significantly improves diagnostic accuracy and enables rapid, reliable rule-out of acute myocardial infarction compared with troponin T alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether combining copeptin with conventional cardiac troponin provides incremental diagnostic accuracy for the rapid rule-out of acute myocardial infarction upon emergency presentation.

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Key result

Copeptin plus troponin T improves AMI diagnostic accuracy over troponin T alone.

95% CI 0.95 to 0.98
P<0.001
n=487

Why the study?

Does the combination of copeptin and troponin T improve the rapid rule out of acute myocardial infarction compared to troponin T alone in patients presenting to the emergency department with suggestive symptoms?

Population

487 consecutive patients presenting to the emergency department with symptoms suggestive of acute myocardial…

Comparison

Measurement of copeptin levels at presentation… vs Troponin T alone

Design

Cohort, blinded fashion (for copeptin measurement)

Authors

TRTobias ReichlinElectrophysiology WHWillibald HochholzerFondazione Edmund Mach CSClaudia StelzigDélégation Paris 5

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

TR Tobias ReichlinInternal medicine physician, University Hospital Basel

“In the very situation of a patient presenting to the Emergency Department with symptoms suggestive of Acute Myocardial Infarction the clinician quickly needs to know whether the person is in real danger or not. Ruling out AMI in this setting is an urgent and unmet need. The use of Copeptin together with Troponin can accelerate the rule out of AMI and thus improves patient management in the ED immensely. Two thirds of these patients may be ruled out with the first blood draw and most of them probably could leave the ED very soon.”

News Coverage

EGEvangelos GiannitsisCardiologist, University Hospital Heidelberg

“Following the BIC-8 interventional trial, the ESC recognizes the safety and efficacy of copeptin recommending its routine use as an additional biomarker for early rule-out of AMI in combination with troponin.”

News Coverage

Implication

Adding copeptin to troponin T at presentation allows for rapid and reliable rule out of acute myocardial infarction, potentially reducing the need for prolonged monitoring.

Key Points

To determine whether combining copeptin with conventional cardiac troponin provides incremental diagnostic accuracy for the rapid rule-out of acute myocardial infarction upon emergency presentation.
Assessed consecutive patients presenting to the emergency department with acute chest pain within 12 hours of symptom onset.
Measured baseline concentrations of copeptin alongside cardiac troponin at initial patient presentation.
Evaluated diagnostic accuracy and negative predictive value using adjudicated final diagnoses based on serial troponin measurements and clinical guidelines.
Combining baseline copeptin with standard cardiac troponin significantly enhanced the area under the receiver operating characteristic curve compared to troponin alone.
The dual-marker strategy of negative copeptin and negative troponin at presentation achieved a negative predictive value exceeding 99% for ruling out acute myocardial infarction.

Study Design

Type

Observational (n=487)

Blinding

Blinded

Structured PICO

Population

487 consecutive patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction.

Exposure

Measurement of copeptin levels at presentation combined with troponin T

Comparator

Troponin T alone

Outcome

Diagnostic accuracy (area under the receiver-operating characteristic curve) for acute myocardial infarction, adjudicated by 2 independent cardiologistssurrogate

Main Result

Absolute Event Rate: 0.97% vs 0.86%

p-value: p=<0.001

Adding copeptin to troponin T at presentation allows for rapid and reliable rule out of acute myocardial infarction, potentially reducing the need for prolonged monitoring.

Cite This Study

Reichlin et al. (2009) conducted an observational in Acute myocardial infarction (n=487). Copeptin combined with troponin T vs. Troponin T alone was evaluated on Area under the receiver-operating characteristic curve for diagnosis of acute myocardial infarction (95% CI 0.95 to 0.98, p=<0.001). Combining copeptin and troponin T at presentation yielded a significantly higher diagnostic accuracy for acute myocardial infarction than troponin T alone (AUC 0.97 vs 0.86, p<0.001).

synapsesocial.com/papers/6aaa2d9a8a8dafe49ec2f410 https://doi.org/10.1016/j.jacc.2009.01.076

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September 16, 2026Journal of the American College of Cardiology

Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction

View Full Paper

Ask AI

Bookmark

Key result

Copeptin plus troponin T improves AMI diagnostic accuracy over troponin T alone.

95% CI 0.95 to 0.98
P<0.001
n=487

Why the study?

Population

487 consecutive patients presenting to the emergency department with symptoms suggestive of acute myocardial…

Comparison

Measurement of copeptin levels at presentation… vs Troponin T alone

Design

Cohort, blinded fashion (for copeptin measurement)

Authors

TRTobias ReichlinElectrophysiology WHWillibald HochholzerFondazione Edmund Mach CSClaudia StelzigDélégation Paris 5

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

TR Tobias ReichlinInternal medicine physician, University Hospital Basel

“In the very situation of a patient presenting to the Emergency Department with symptoms suggestive of Acute Myocardial Infarction the clinician quickly needs to know whether the person is in real danger or not. Ruling out AMI in this setting is an urgent and unmet need. The use of Copeptin together with Troponin can accelerate the rule out of AMI and thus improves patient management in the ED immensely. Two thirds of these patients may be ruled out with the first blood draw and most of them probably could leave the ED very soon.”

News Coverage

EGEvangelos GiannitsisCardiologist, University Hospital Heidelberg

“Following the BIC-8 interventional trial, the ESC recognizes the safety and efficacy of copeptin recommending its routine use as an additional biomarker for early rule-out of AMI in combination with troponin.”

News Coverage

Implication

Adding copeptin to troponin T at presentation allows for rapid and reliable rule out of acute myocardial infarction, potentially reducing the need for prolonged monitoring.

Key Points

To determine whether combining copeptin with conventional cardiac troponin provides incremental diagnostic accuracy for the rapid rule-out of acute myocardial infarction upon emergency presentation.
Assessed consecutive patients presenting to the emergency department with acute chest pain within 12 hours of symptom onset.
Measured baseline concentrations of copeptin alongside cardiac troponin at initial patient presentation.
Evaluated diagnostic accuracy and negative predictive value using adjudicated final diagnoses based on serial troponin measurements and clinical guidelines.
Combining baseline copeptin with standard cardiac troponin significantly enhanced the area under the receiver operating characteristic curve compared to troponin alone.
The dual-marker strategy of negative copeptin and negative troponin at presentation achieved a negative predictive value exceeding 99% for ruling out acute myocardial infarction.

Study Design

Type

Observational (n=487)

Blinding

Blinded

Structured PICO

Population

487 consecutive patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction.

Exposure

Measurement of copeptin levels at presentation combined with troponin T

Comparator

Troponin T alone

Outcome

Diagnostic accuracy (area under the receiver-operating characteristic curve) for acute myocardial infarction, adjudicated by 2 independent cardiologistssurrogate

Main Result

Absolute Event Rate: 0.97% vs 0.86%

p-value: p=<0.001

Adding copeptin to troponin T at presentation allows for rapid and reliable rule out of acute myocardial infarction, potentially reducing the need for prolonged monitoring.

Cite This Study

synapsesocial.com/papers/6aaa2d9a8a8dafe49ec2f410 https://doi.org/10.1016/j.jacc.2009.01.076

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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