第58届ACC会议总是能给大家带来新的启迪。在今日的ACC会上，利用Copeptin的增量价值来快速排除急性心肌梗死的研究为临床医生带来了希望，该新方法可以确保临床医生及时、准确地判断无心脏病发作患者有无AMI。研究发现，如果胸痛患者入院时肌钙蛋白T和copeptin的检测结果均呈阴性（该研究中有三分之二的患者正是如此），有99.4%的患者可能并无急性心肌梗死（AMI）或心脏病发作；只有标志物之一或均为阳性者才有必要留急诊室监测几小时。 

    来自瑞士Basel 大学附属医院内科的Tobias Reichlin教授说，“可以对首次胸痛患者5-6小时检测血肌钙蛋白是否阳性来排除心肌梗死引发的胸痛。如果在急诊室初测结果显示阴性，判断该患者无心脏病发作会显得不安全，他/她仍需留急诊室监视心电图变化，并于4-6小时后重新检测。”

    通过观察血液中copeptin水平可以作为急性内应力的标志物，Reichlin博士和他的研究小组试图确定copeptin在快速排除AMI方面的增量价值。初发胸痛与急性心肌梗死关联对患者来说是一个巨大的压力，首发症状后患者copeptin水平早期最高。
肌钙蛋白检测已经非常成功地使用了15年，并使AMI诊断得到明显改观。然而，胸痛症状非常不具有特异性，并且80%以上的胸痛患者最终是由于AMI以外的其他原因引起。因此，排除AMI所需要的时间很大程度上决定于急诊室使用的资源。
虽然肌钙蛋白检测在诊断AMI方面具有强有力的效力，在急诊室快速排除心肌梗死的药物治疗方面仍未满足需要。问题是安全排除心肌梗死是有时间窗的。

    Reichlin博士说，“如果我们能及早确定绝对不是AMI的患者并让其回家，就可以节省时间、金钱以及抚慰紧张的心灵。通过结合我们自身的两个重要的信号，肌钙蛋白T对应心脏损伤及copeptin对应急性内应力，使用这两个简单的血液检测，我们就能够显着提高对急性心肌梗死的早期诊断。”

    利用Copeptin的增量价值来快速排除急性心肌梗死，是一项多中心研究，旨在提高对可疑AMI患者的实践性治疗和满足医生、患者及经济发展的需要。这项研究始于2006年4月，目前已经观测了在急诊室连续入选的756例有可疑AMI症状的患者血copepetin水平。

（任芳 吕树铮  首都医科大学附属北京安贞医院）

英文原文：
RESEARCHERS PRESENT NEW WAY TO RAPIDLY RULE OUT ACUTE MYOCARDIAL INFARCTION
Study Shows New Method May Save Time and Money during Possible AMI Diagnosis

Orlando， FL – The Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction study examines a promising new method for doctors to conclusively ensure in a timely and accurate manner that a patient is not having a heart attack， according to research presented at the American College of Cardiology’s 58th Annual Scientific Session.  ACC.09 is the premier cardiovascular medical meeting， connecting cardiologists and cardiovascular specialists to the latest and most innovative findings in cardiovascular science. 

If a patient suffering chest pains tested negative at admission for both troponin T and copeptin， which was the case in two-thirds of all patients studied， then there was a 99.4 percent probability that the patient was not having an acute myocardial infarction (AMI) or heart attack， the study found. Only those in the remaining minority of patients who were positive for either marker or both would need to stay in the emergency room for monitoring and retesting a few hours later.  

“It can take between four to six hours from the first chest pain for the troponin test to become positive in the blood and to dismiss myocardial infarction as the cause of the chest pains，” said Tobias Reichlin， M.D.， Department of Internal Medicine， University Hospital Basel， Switzerland. “Therefore， if the initial test in the emergency room shows negative， then there is no security that the patient is not having a heart attack and he/she will need to stay in the emergency room being monitored on an ECG-machine and retested four to six hours later.” 

By looking at the copeptin levels in the blood as a marker of acute endogenous stress， Dr. Reichlin and his team of investigators sought to determine the incremental value of copeptin for rapid rule out of AMI. Since the onset of chest pain associated with AMI is an enormous stress for the patient， copeptin levels were highest in patients presenting very early after the onset of symptoms. 

Troponin tests have been used with great success for the past 15 years and have markedly improved the diagnosis of AMI. However， chest pain is very nonspecific and more than 80 percent of patients with chest pain ultimately suffer from conditions other than AMI. Therefore， the time needed for rule out of AMI largely determines resource use in the emergency department. 

While troponin tests are extremely powerful for rule in the diagnosis of AMI， rapid rule out of myocardial infarction in the emergency room is a major unmet need in medicine. The problem with this is the timeframe needed to safely rule out myocardial infarction. 

“If we can determine that it is absolutely not AMI earlier and send home the majority of the patients， we can save time， money and ease the mind of everyone involved，” Dr. Reichlin said. “By combining two important signals of our body， troponin T for heart damage and copeptin for acute endogenous stress， we were able to markedly improve the early diagnosis of acute myocardial infarction using two simple blood tests.” 

The Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction was evaluated in a multicenter study designed to improve the daily practice of treating patients who exhibit symptoms suggestive of AMI and meet the needs of the doctor， patient and the economy.  

The study， which began in April 2006， looked at levels of copepetin at presentation in 756 consecutive emergency room patients with symptoms suggestive of AMI.