Copeptin as a Prognostic Marker in Acute Chest Pain and Suspected Acute Coronary Syndrome

Morawiec, Beata; Kawecki, Damian; Przywara-Chowaniec, Brygida; Opara, Mariusz; Muzyk, Piotr; Lam, Ho; Tat, Lui Chun; Gabrysiak, Artur; Müller, Olivier; Nowalany-Kozielska, Ewa

doi:10.1155/2018/6597387

Cited by 11 publications

(11 citation statements)

References 22 publications

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“…In contrast to cTn, the release of copeptin is unspecific and may be stimulated by numerous acute clinical pathologies, including acute heart failure, pulmonary embolism, and sepsis [10][11][12][13]. Previously, elevated copeptin values in patients with suspected ACS but also non-ACS conditions were found to confer incremental prognostic information beyond an increased hs-cTn [10,14]. However, Stallone et al found that the association of elevated copeptin levels with mortality may be largel, y explained by age and comorbidities [9].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

Waldsperger

Biener

Stoyanov

et al. 2020

JCM

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Aims: We aimed to assess the prognostic role of copeptin in patients presenting to the emergency department with acute symptoms and increased high-sensitivity cardiac troponin T. Methods: A total of 3890 patients presenting with acute symptoms to the emergency department of Heidelberg University Hospital were assessed for increased hs-cTnT (>14 ng/L) from three cohorts: the Heidelberg Acute Coronary Syndrome (ACS) Registry (n = 2477), the BIOPS Registry (n = 320), and the ACS OMICS Registry (n = 1093). In a pooled analysis, 1956 patients remained, comprising of 1600 patients with ACS and 356 patients with non-ACS. Results: Median follow-up was 1468 days in the ACS cohort and 709 days in the non-ACS cohort. Elevated copeptin levels (>10 pmol/L) were found in 1174 patients (60.0%) in the entire cohort (58.1% in ACS and 68.5% in non-ACS, respectively) and mortality rates were significantly higher than in patients with normal copeptin levels (29.0% vs. 10.7%, p < 0.001). In a multivariate Cox regression, elevated copeptin was independently associated with all-cause death in the ACS (HR = 1.7, 1.3–2.3, p = 0.002) and non-ACS cohort (HR = 2.7, 1.4–5.0, p = 0.0018). Conclusion: Copeptin may aid in identifying patients at risk for adverse outcomes in patients with increased levels of hs-cTnT in ACS patients and in non-ACS conditions.

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Section: Introductionmentioning

confidence: 99%

Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

Waldsperger

Biener

Stoyanov

et al. 2020

JCM

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“…10,24,25) In a study, Morawiec et al found that 17.4 pmol/L was a significant copeptin value for NSTEMI patients. 26) In another study, Reinstadler et al found that the threshold for the copeptin level was 16.7 pmol/L to predict the left ventricle's performance and adverse remodeling in STEMI patients. 22) In our study, the threshold value of 18.3 pmol/L, which was chosen to predict a high SYNTAX score, is consistent with that in the literature.…”

Section: Discussionmentioning

confidence: 99%

Could Serum Copeptin Level Be an Indicator of Coronary Artery Disease Severity in Patients with Unstable Angina?

et al. 2021

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This study aimed to identify the serum copeptin levels in patients diagnosed with unstable angina (UA) and evaluate the relationship between the patients' copeptin levels and angiographic severity.A total of 200 patients who were diagnosed with UA and underwent coronary angiography were included in the study. Clinical, electrocardiographic, echocardiographic, and laboratory data (high-sensitivity cardiac troponin T and copeptin levels) as well as The Global Registry of Acute Coronary Events (GRACE) 1.0 risk score were recorded upon admission. Moreover, the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated following coronary angiography.We isolated and defined two subgroups within our study population: group 1 included patients with nonsignificant coronary artery disease (CAD) (< 50% diameter stenosis, n = 105); group 2 included patients with significant CAD (!50% diameter stenosis, n = 95). The number of cases with a GRACE score higher than 140 was significantly higher in group 2 than in group 1 (P < 0.001). The SYNTAX scores and copeptin levels were significantly higher in group 2 than in group 1 (P < 0.001 for both). A positive correlation was observed between the copeptin levels and SYNTAX scores (r = 0.683; P < 0.001), and the cut-off level of copeptin was 18.3 pmol/L (sensitivity of 74.7%, specificity of 83.8%, and area under the curve of 0.795).This study suggests that it may be beneficial to use conventional scoring systems and serum copeptin levels when identifying high-risk UA patients.

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“…Estimation of the probability of the development of adverse events in the short term after admission is crucial in regard to triage, diagnostic, and therapeutic decisions. Biomarker-based algorithms have a well-established role in this setting [ 1 , 8 , 14 , 22 ]; however, high safety is achieved with serial sampling. Considering the constant need to shorten the time to diagnosis, several clinical scores, e.g., the modified HEART score, are under debate.…”

Section: Discussionmentioning

confidence: 99%

“…Even though lower than hs-TnT/mHS/copeptin, the hs-TnT/mHS algorithm still remains of better sensitivity/NPV than hs-TnT alone, thus reinforcing the interest for the mHS. Copeptin has an advantage over hs-TnT for long-term risk stratification [ 22 ] but has not been analysed neither with mHS nor hs-Tn for short-term risk. Combination of hs-TnT, copeptin, and the mHS, which represent different pathophysiological axes and carry complementary information on the origin and the character of chest pain and possible myocardial ischemia, results in an algorithm of excellent prognostic performance.…”

Section: Discussionmentioning

confidence: 99%

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Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients

et al. 2018

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Background Clinical short-term risk stratification is a recommended approach in patients with chest pain and possible acute myocardial infarction (AMI) to further improve high safety of biomarker-based rule-out algorithms. The study aim was to assess clinical performance of baseline concentrations of high-sensitivity cardiac troponin T (hs-TnT) and copeptin and the modified HEART score (mHS) in early presenters to the emergency department with chest pain. Methods This cohort study included patients with chest pain with onset maximum of 6 h before admission and no persistent ST-segment elevation on electrocardiogram. hs-TnT, copeptin, and the mHS were assessed from admission data. The diagnostic and prognostic value for three baseline rule-out algorithms: (1) single hs-TnT < 14 ng/l, (2) hs-TnT < 14 ng/l/mHS ≤ 3, and (3) hs-TnT < 14 ng/l/mHS ≤ 3/copeptin < 17.4 pmol/l, was assessed with sensitivity and negative predictive value. Primary diagnostic endpoint was the diagnosis of AMI. Prognostic endpoint was death and/or AMI within 30 days. Results Among 154 enrolled patients, 44 (29%) were classified as low-risk according to the mHS; AMI was diagnosed in 105 patients (68%). For ruling out AMI, the highest sensitivity and NPV from all studied algorithms were observed for hs-TnT/mHS/copeptin (100%, 95% CI 96.6–100, and 100%, 95% CI 75.3–100). At 30 days, the highest event-free survival was achieved in patients stratified with hs-TnT/mHS/copeptin algorithm (100%) with 100% (95% CI 75.3–100) NPV and 100% (95% CI 96.6–100) sensitivity. Conclusions The combination of baseline hs-TnT, copeptin, and the mHS has an excellent sensitivity and NPV for short-term risk stratification. Such approach might improve the triage system in emergency departments and be a bridge for inclusion to serial blood sampling algorithms.

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Copeptin as a Prognostic Marker in Acute Chest Pain and Suspected Acute Coronary Syndrome

Cited by 11 publications

References 22 publications

Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

Could Serum Copeptin Level Be an Indicator of Coronary Artery Disease Severity in Patients with Unstable Angina?

Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients

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