Ann Lab Med.  2020 Jan;40(1):7-14. 10.3343/alm.2020.40.1.7.

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

Affiliations
  • 1Department of Laboratory Medicine, Chung Ang University Hospital, Seoul, Korea.
  • 2Department of Laboratory Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. pwpark@gilhospital.com
  • 3Department of Internal Medicine, Gimpo Woori Hospital, Gimpo, Korea.
  • 4Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.

Abstract

BACKGROUND
Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI).
METHODS
We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed.
RESULTS
The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients.
CONCLUSIONS
The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

Keyword

Acute myocardial infarction; Copeptin; Troponin I; Creatine kinase myocardial band; Performance; ST elevation myocardial infarction; Non-ST elevation myocardial infarction
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