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

• Kim J
• Kim J
• Lim J
• Kim SY
• Kwon GC
• Koo SH

• KMID: 2538579
• DOI: http://doi.org/10.47429/lmo.2022.12.1.20

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

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  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.

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