Evaluation of Copeptin for Diagnosing Non-ST Segment Elevation Acute Myocardial Infarction in Patients with Chest pain and Mild Troponin I Elevation
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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 in- crease the diagnostic accuracy for AMI. Therefore, we assessed the utility of copeptin in the diagnosis of non-ST-segment elevation myocardial in- farction (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 mea- sured 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) ( < 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, = 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.
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 in- crease the diagnostic accuracy for AMI. Therefore, we assessed the utility of copeptin in the diagnosis of non-ST-segment elevation myocardial in- farction (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 mea- sured 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) ( < 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, = 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.
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