Diagnostic and Prognostic Impact of Copeptin and High-Sensitivity Cardiac Troponin T in Patients With Pre-Existing Coronary Artery Disease and Suspected Acute Myocardial Infarction

Study Questions:

What is the predictive value of copeptin levels towards diagnosis of acute myocardial infarction (AMI) and prognosis in patients presenting with chest pain?

Methods:

The prognostic impact of copeptin levels in combination with cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT) was evaluated in 1,170 consecutive patients presenting with symptoms suggestive of AMI.

Results:

AMI was the final diagnosis in 78 patients. Copeptin was higher in patients with AMI than in those who ruled out (26 vs. 7 pmol/L, p < 0.001). The diagnostic accuracy for AMI was significantly higher for the combination of copeptin and cTnT than for cTnT alone (0.94 vs. 0.86, p < 0.001). The combination of copeptin and hs-cTnT (0.94) was trending to superiority compared with hs-cTnT alone (0.92, p = 0.11). The combination of copeptin and the cTn assays improved the negative predictive value up to 99.5% to rule out AMI. Copeptin was a strong and independent predictor of 1-year mortality (hazard ratio, 4.18-4.63) and irrespective of cTn levels, patients with low levels of copeptin had an excellent prognosis compared with patients with raised levels of both copeptin and cTn (1-year mortality 2.8-3.6% vs. 23.1-33.8%, p < 0.001).

Conclusions:

The authors concluded that copeptin significantly improves the diagnostic accuracy for AMI if used in addition to cTnT, and provides independent prognostic information.

Perspective:

Copeptin is a relatively stable peptide fragment of the antidiuretic hormone precursor pro-arginine-vasopressin, and is therefore sensitive to hemodynamic stressors. Along with other recently published biomarkers that may reflect hemodynamic stress (i.e., midregional pro-A-type natriuretic peptide), copeptin may be useful to risk stratify patients presenting with AMI. It may also be useful in the diagnosis of AMI in some cases, especially to improve the negative predictive value of cTns. Additional studies are necessary to determine how copeptin may guide therapeutic interventions in AMI patients.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Prognosis, Coronary Artery Disease, Myocardial Infarction, Cytoskeletal Proteins, Vasopressins, Biological Markers, Peptides, Cardiology, Troponin T, Hemodynamics, Troponin


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