Lab Med Online.  2022 Jan;12(1):20-25. 10.47429/lmo.2022.12.1.20.

Evaluation of Copeptin for Diagnosing Non-ST Segment Elevation Acute Myocardial Infarction in Patients with Chest pain and Mild Troponin I Elevation

Affiliations
  • 1Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea

Abstract

Background
Although troponin assays improve the detection of acute myocardial infarction (AMI), troponin elevation is observed in various non-ischemic conditions. Studies have proposed that, when used in combination with a cardiac troponin I (TnI) assay, serum copeptin would increase the diagnostic accuracy for AMI. Therefore, we assessed the utility of copeptin in the diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI).
Methods
A total of 180 patients (age, 68.2±13.3 years; M:F, 113:67) were enrolled for the study, who are presented with chest pain and mild TnI elevation (0.04–1.0 ng/mL) in the emergency department, excluding those with ST elevation on the electrocardiogram. Copeptin was measured using an automated immunofluorescent assay, Copeptin proAVP KRYPTOR (Thermo Fisher Scientific, Germany).
Results
The subjects included 49 patients (27.2%) who had NSTEMI, 64 (35.6%) patients who had angina, and 67 (37.2%) patients who had other diseases. The median (interquartile range) copeptin level in the NSTEMI group (69.57 [35.56–172.50] pmol/L) was significantly higher than those in the angina group (7.64 [3.36–17.19] pmol/L) and the other diseases group (6.75 [4.33–13.02] pmol/L) (P<0.0001). At the 14.4 pmol/L cutoff for copeptin, TnI plus copeptin had a higher area under the curve than TnI plus CK-MB (0.898 vs. 0.711, P=0.0001) for diagnosing NSTEMI.
Conclusions
Non-ischemic mild TnI elevation is common. Copeptin levels provide additional information for differentiating NSTEMI from non-NSTEMI patients with mild TnI elevation. The combination of copeptin and TnI could improve NSTEMI diagnosis by excluding non-ischemic mild TnI elevation.

Keyword

Copeptin; Troponin; Creatine kinase-MB; Non-ST elevation myocardial infarction

Figure

  • Fig. 1 ROC curve analysis results showing the diagnostic performance of CK-MB, copeptin, and the sum of marker scores in NSTEMI group versus non-NSTEMI group in patients presented with chest pain and mild TnI (>0.4 and <1.0 ng/mL) elevation. Abbreviation: ROC, receiver operating characteristics; NSTEMI, non-ST elevation myocardial infarction.


Reference

1. Brady WJ, Roberts D, Morris F. 1999; The nondiagnostic ECG in the chest pain patient: normal and nonspecific initial ECG presentations of acute MI. Am J Emerg Med. 17:394–7. DOI: 10.1016/S0735-6757(99)90095-5. PMID: 10452442.
Article
2. Ruddox V, Mathisen M, Otterstad JE. 2012; Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome-a systematic literature search. BMC Med. 10:58. DOI: 10.1186/1741-7015-10-58. PMID: 22691301. PMCID: PMC3391179.
Article
3. Kitamura M, Hata N, Takayama T, Hirayama A, Ogawa M, Yamashina A, et al. 2013; High-sensitivity cardiac troponin T for earlier diagnosis of acute myocardial infarction in patients with initially negative troponin T test--comparison between cardiac markers. J Cardiol. 62:336–42. DOI: 10.1016/j.jjcc.2013.06.005. PMID: 23867331.
Article
4. Boeddinghaus J, Reichlin T, Cullen L, Greenslade JH, Parsonage WA, Hammett C, et al. 2016; Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction by use of high-sensitivity cardiac troponin I. Clin Chem. 62:494–504. DOI: 10.1373/clinchem.2015.249508. PMID: 26797687.
Article
5. Tanindi A, Cemri M. 2011; Troponin elevation in conditions other than acute coronary syndromes. Vasc Health Risk Manag. 7:597–603. DOI: 10.2147/VHRM.S24509. PMID: 22102783. PMCID: PMC3212425.
Article
6. Morgenthaler NG. 2010; Copeptin: a biomarker of cardiovascular and renal function. Congest Heart Fail. 16:S37–44. DOI: 10.1111/j.1751-7133.2010.00177.x. PMID: 20653710.
Article
7. Stengaard C, Sørensen JT, Ladefoged SA, Lassen JF, Rasmussen MB, Pedersen CK, et al. 2017; The potential of optimizing prehospital triage of patients with suspected acute myocardial infarction using high-sensitivity cardiac troponin T and copeptin. Biomarkers. 22:351–60. DOI: 10.1080/1354750X.2016.1265008. PMID: 27903076.
Article
8. Möckel M, Searle J, Hamm C, Slagman A, Blankenberg S, Huber K, et al. 2015; Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome(ACS): a randomized, controlled clinical process study. Eur Heart J. 36:369–76. DOI: 10.1093/eurheartj/ehu178. PMID: 24786301. PMCID: PMC4320319.
9. Slagman A, Searle J, Müller C, Möckel M. 2015; Temporal release pattern of copeptin and troponin T in patients with suspected acute coronary syndrome and spontaneous acute myocardial infarction. Clin Chem. 61:1273–82. DOI: 10.1373/clinchem.2015.240580. PMID: 26341999.
Article
10. Raskovalova T, Twerenbold R, Collinson PO, Keller T, Bouvaist H, Folli C, et al. 2014; Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 3:18–27. DOI: 10.1177/2048872613514015. PMID: 24562800. PMCID: PMC3932778.
Article
11. Ananth V, Beig JR, Tramboo NA, Rasool R, Choh NA, Bashir S, et al. 2016; Does plasma copeptin level at admission predict final infarct size in ST-elevation myocardial infarction. Int J Cardiol. 219:326–30. DOI: 10.1016/j.ijcard.2016.06.025. PMID: 27344134.
Article
12. Mahajan VS, Jarolim P. 2011; How to interpret elevated cardiac troponin levels. Circulation. 124:2350–4. DOI: 10.1161/CIRCULATIONAHA.111.023697. PMID: 22105197.
Article
13. Nickel CH, Bingisser R, Morgenthaler NG. 2012; The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department. BMC Med. 10:7. DOI: 10.1186/1741-7015-10-7. PMID: 22264220. PMCID: PMC3275505.
Article
14. Vargas KG, Kassem M, Mueller C, Wojta J, Huber K. 2016; Copeptin for the early rule-out of non-ST-elevation myocardial infarction. Int J Cardiol. 223:797–804. DOI: 10.1016/j.ijcard.2016.08.304. PMID: 27573613.
Article
15. Mueller C, Möckel M, Giannitsis E, Huber K, Mair J, Plebani M, et al. 2018; Use of copeptin for rapid rule-out of acute myocardial infarction. Eur Heart J Acute Cardiovasc Care. 7:570–6. DOI: 10.1177/2048872617710791. PMID: 28593800.
Article
16. Jeong JH, Seo YH, Ahn JY, Kim KH, Seo JY, Chun KY, et al. 2020; Performance of copeptin for early diagnosis of acute myocardial infarction in an emergency department setting. Ann Lab Med. 40:7–14. DOI: 10.3343/alm.2020.40.1.7. PMID: 31432633. PMCID: PMC6713663.
Article
17. Shin H, Jang BH, Lim TH, Lee J, Kim W, Cho Y, et al. 2018; Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis. PLoS One. 13:e0200379. DOI: 10.1371/journal.pone.0200379. PMID: 29979797. PMCID: PMC6034895.
Article
18. Poldervaart JM, Langedijk M, Backus BE, Dekker IMC, Six AJ, Doevendans PA, et al. 2017; Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol. 227:656–61. DOI: 10.1016/j.ijcard.2016.10.080. PMID: 27810290.
Article
19. Sabatine MS, Morrow DA, de Lemos JA, Gibson CM, Murphy SA, Rifai N, et al. 2002; Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide. Circulation. 105:1760–3. DOI: 10.1161/01.CIR.0000015464.18023.0A. PMID: 11956114.
Article
20. Tang WH, Iqbal N, Wu Y, Hazen SL. 2013; Usefulness of cardiac biomarker score for risk stratification in stable patients undergoing elective cardiac evaluation across glycemic status. Am J Cardiol. 111:465–70. DOI: 10.1016/j.amjcard.2012.10.027. PMID: 23219176. PMCID: PMC3641751.
Article
21. Dobsa L, Edozien KC. 2013; Copeptin and its potential role in diagnosis and prognosis of various diseases. Biochem Med (Zagreb). 23:172–90. DOI: 10.11613/BM.2013.021. PMID: 23894863. PMCID: PMC3900057.
Article
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