COPeptin for diagnosis and prediction in Acute Coronary Syndrome (COPACS) Study: design and objectives

Introduction

Chest pain is one of the most frequent and challenging clinical settings in emergency departments worldwide [1]. While the diagnosis and subsequent optimal management in ST segment elevation myocardial infarction (STEMI) are well established, rapid diagnosis of patients without persistent ST-segment elevation on ECG remains a challenge. Current guidelines on diagnosis and treatment of STEMI and non-ST-segment elevation acute coronary syndrome (non-STEACS) emphasize maximal shortening of time to diagnosis and treatment in high-risk patients [2–4]. Available tools are effective but time consuming. It is recommended to measure cardiac troponin, a gold standard marker of myocardial damage, in serial blood samples [3]. Copeptin, the C-terminal part of the prohormone for vasopressin, is emerging as a marker of acute endogenous stress. Due to its characteristic release pattern with an immediate increase a few minutes after symptom onset, together with cardiac troponin, a marker specific for myocardial injury, it could fill the gap and effectively shorten the time to diagnosis. Also in the context of early risk stratification crucial for optimal management, copeptin has high potential to be a rapid information tool [5, 6].
Below, we present the design of the COPACS (COPeptin for Acute Coronary Syndrome) Study, whose aim is to assess the role of copeptin in diagnosis and prediction of adverse events in a population of patients with chest pain without persistent T-segment elevation on ECG already at presentation, with regard to high-sensitive troponin T (hs-TnT).

General information

COPACS is a prospective observational study of the diagnostic and prognostic performance of copeptin in patients presenting to the Emergency Department with chest pain without persistent ST-segment elevation on ECG (non-conclusive ECG). Enrollment is conducted in the 2nd Department of Cardiology, Zabrze, Medical University of Silesia, Katowice, Poland and is planned to be held in two rounds: 1) between December 15, 2011 and December 31, 2013, 2) between October 01, 2015 and December 31, 2016. Patients are enrolled according to prespecified inclusion and exclusion criteria (Table I).
Criteria of 6-hour chest pain was set as a result of previously published data on the profile of copeptin release in patients with acute coronary syndromes, which indicate rapid release with peak concentrations at 1–2 h from symptom onset followed by a decrease...


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