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

• Jeong JH
• Seo YH
• Ahn JY
• Kim KH
• Seo JY
• Chun KY
• Lim YS
• Park PW

• KMID: 2457487
• DOI: http://doi.org/10.3343/alm.2020.40.1.7

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

MeSH Terms

Acute Coronary Syndrome
Angina, Unstable
Area Under Curve
Chest Pain
Creatine Kinase
Diagnosis
Early Diagnosis*
Emergencies*
Emergency Service, Hospital*
Humans
Myocardial Infarction*
Prognosis
Prospective Studies
ROC Curve
Sensitivity and Specificity
Troponin I
Creatine Kinase
Troponin I

Figure

• 

  Fig. 1 ROC curves for CK-MB, TnI, and copeptin according to the time of chest pain onset in AMI patients. The ROC curve plots sensitivity on the Y-axis and (1-specificity) on the X-axis. The area under the curve (AUC) of each marker is presented in each graph. Copeptin as a single marker was superior to CK-MB within six hours [(A)–(C)] and to TnI within two hours [(A) & (B)] in the STEMI group (P<0.05). Copeptin showed better diagnostic performance than CK-MB within two hours [(G) & (H)] and TnI within one hour in the AMI group (G) (P<0.05).Abbreviations: STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; AMI, acute myocardial infarction; CK-MB, creatine kinase myocardial band; TnI, troponin I.

• 

  Fig. 2 ROC curves for combined markers according to the time of chest pain onset in AMI patients. A combination of the three markers showed the highest ROC curves in all patient groups. Copeptin plus TnI showed better diagnostic performance than TnI plus CK-MB in the STEMI [(A)–(C)] and AMI [(G)–(I)] groups (P<0.05).Abbreviations: STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; AMI, acute myocardial infarction; CK-MB, creatine kinase myocardial band; TnI, troponin I; copep, copeptin.

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