Temporal Release Pattern of Copeptin and Troponin T in Patients with Suspected Acute Coronary Syndrome and Spontaneous Acute Myocardial Infarction

Abstract

BACKGROUND The release pattern of copeptin during the initial 36 h of spontaneous acute myocardial infarction (AMI) has received relatively little investigation but may provide important information on optimal timing of diagnostic measurements. METHODS We investigated the release pattern of copeptin and cardiac troponin T in patients with suspected acute coronary syndrome (ACS). Blood samples were collected in the ambulance, at admission, and after 2, 4, 6, and 12–36 h. Copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in heparin plasma samples. RESULTS Of 93 patients studied, 37 (39.8%) had ST-elevation myocardial infarction (STEMI), 20 (21.5%) non-STEMI, 20 (21.5%) unstable angina pectoris (UAP), and 16 (17.2%) non-ACS diagnoses. Peak copeptin concentrations were detected during ambulance transport for NSTEMI patients [median 94.0 pmol/L, interquartile range (IQR) 53.3–302.1 pmol/L] and at admission for patients with STEMI (70.0 pmol/L, 22.0–144.8 pmol/L). In patients with AMI, copeptin decreased significantly over time (P < 0.0001). This was true for patients with STEMI (P = 0.005) and non-STEMI (P = 0.021). The diagnostic performance during ambulance transport was similar for hs-cTnT (area under the ROC curve 0.75, 95% CI 0.62–0.88) and copeptin (0.81, 0.69–0.92). In early presenters (n = 52), no patient with AMI was initially (in ambulance or at admission) negative for copeptin, resulting in an area under the ROC curve of 0.963 for ambulance values and a negative predictive value of 100%. In late presenters, the negative predictive value of copeptin was 50% in ambulance and at admission. CONCLUSIONS Our analysis is the first to show a consistent early increase in copeptin at first medical contact in the ambulance and a decrease to routine values within 12–36 h in patients presenting early with spontaneous AMI.

Prehospital diagnosis of patients with acute myocardial infarction

“…A total of 10 studies, investigating the utility of POCT of biomarkers in the ambulance, have been performed and are summarized in Table 1 [53][54][55][56][57][58][59][60][61][62]. Many studies include a low number of patients with a high prevalence of AMI which suggests selection.…”

Copeptin Release in Cardiac Surgery–A New Biomarker to Identify Risk Patients?

“…The mean CPB time was 91 ± 29 minutes. Inhospital stay was 9 days (IQR, [8][9][10][11][12][13][14]. There were no in-hospital or 30-day mortality.…”

“…Copeptin has been studied as a biomarker in cardiology and proved to be prognostic in heart failure and discriminative in acute ischemic heart disease [9][10][11] . The release pattern of copeptin has been described in patients with acute coronary syndrome and acute myocardial infarction 12 . A previous study on patients undergoing transcoronary ablation of septal hypertrophy showed that copeptin is released quickly within 30 minutes after induction of myocardial infarction and maximum after 90 minutes and returns to baseline within 24 hours 13 .…”

In Search of the 1-Hour Rule-Out for Acute Myocardial Infarction

“…The blood concentration of copeptin, the C-terminal of the prohormone arginine vasopressin, increases within 90 min of MI onset. Compared with prior-generation cardiac troponin testing, copeptin is released earlier after symptom onset and theoretically allows for earlier detection of myocardial stress (8 ). Combined with negative conventional cardiac troponin results, a single normal copeptin value at presentation has been shown to improve the NPV compared with cardiac troponin alone (9,10 ).…”