Correlation of Plasma Copeptin Levels and Early Diagnosis
of Acute Myocardial Infarction Compared with Troponin-T
Sumitra Piyanuttapull MD*
Affiliation :
* Department of Emergency Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Patients present with chest pain. Electrocardiography (ECG) is used and troponin-T levels slowly increases.
Diagnosis of myocardial infarction requires prolonged monitoring, over six to nine hours, for serial blood sampling. It is
the cause of delayed treatment and lead to a crowded emergency room. Troponin is a marker of myocardial necrosis, the
gold standard in detection of acute myocardial infarction (AMI). Copeptin, the C-terminal part of the vasopressin prohormone,
as a marker of acute endogenous stress, adds diagnosis information to cardiac troponin in early evaluation of patients with
suspected myocardial infarction.
Objective : To determine the correlation between plasma copeptin level and troponin-T. It is also to determine if the copeptin
level can be used as early diagnosis in patients who present with chest pain and are suspected to be acute myocardial
infarction (AMI).
Material and Method: Patients with chest pain that presented to the emergency department of Rajavithi Hospital between
October 2010 and October 2011 and were suspected to have myocardial infarction were consecutively enrolled in the present
study. The level of plasma copeptin and troponin-T were measured at presentation and six hours after presentation.
Results : One hundred fifty patients presented to the emergency department with chest pain. Their average age was
66.717.78 years. The mean plasma copeptin level was 13.915.01 pmol/l in acute myocardial infarction. Plasma copeptin
level increased compared with troponin-T. Plasma copeptin level increased and correlated with troponin-T to diagnose
myocardial infarction (r = 0.317) at presentation. It further increased and correlated (r = 0.562) at six hours after presentation.
Plasma copeptin levels for diagnosis of ST elevate myocardial infarction (STEMI) at presentation have an area under curve
(AUC) = 0.91, p<0.001, sensitivity 90.9%, and specificity 87.8%. The non-ST elevated myocardial infarction (NSTEMI)
have an area under curve (AUC) = 0.71, p<0.001, sensitivity 88.8%, specificity 69.8%, and cut-off point of 10.25 pmol/l.
Conclusion : Plasma copeptin can be used for early diagnosis of myocardial infarction. The additional use of copeptin to
Troponin-T allows for a rapid triage of chest pain patients to an early diagnosis of non-ST elevation myocardial infarction.
Keywords : Copeptin, Troponin-T, Myocardial infarction
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