Copeptin and high sensitive troponin for a rapid rule out of acute myocardial infarction?
BACKGROUND
Rapid and reliable exclusion of acute myocardial infarction during emergency department triage is an important clinical need. The purpose of this study was to evaluate the potential role of copeptin, a marker of acute endogenous stress, together with high sensitive troponin-I for a rapid and early rule-out of acute myocardial infarction.


METHODS
Copeptin and myoglobin were measured in 80 subjects presenting to the emergency department with chest pain and symptoms suggestive of acute myocardial infarction, 46 patients had a negative high sensitive troponin-I concentration at presentation, 3, 6 and 12 hours; whereas 34 patients had negative or very low high sensitive troponin-I at presentation, but rising troponin values at 3, 6 and 12 hours.


RESULTS
Copeptin was significantly higher in patients with evidence of myocardial damage (median 92.2 pmol/L vs 8.5 pmol/L, p < 0.0001). The area under the receiver-operating characteristic curve (AUC) for copeptin at initial presentation was 0.86 (95 % confidence interval, CI: 0.76 to 0.93), which was significantly higher than 0.68 (95% CI: 0.57 to 0.78, p < 0.05) for myoglobin but not significantly different from 0.88 (95% CI: 0.79 to 0.93) for high sensitive troponin-I. The combination of high sensitive troponin-I and copeptin resulted in an AUC of 0.94 (95% CI: 0.86 to 0.98), while the combination of high sensitive troponin-I and myoglobin results in an AUC of 0.89 (95% CI: 0.81 to 0.95).


CONCLUSIONS
Copeptin concentrations are more sensitive than myoglobin as an early marker of myocardial damage. Although copeptin provides significant incremental value on top of high sensitivity troponin-I, myoglobin does not.
Clinical Chemistry and Hematology Laboratory, Clinical Pathology Dept. San Bortolo Hospital, Vicenza, Italy. davide.giavarina@ulssvicenza.it
Davide
D
Giavarina
Mariarosa
M
Carta
Antonio
A
Fortunato
Mary Lou
ML
Wratten
Oliver
O
Hartmann
Giuliano
G
Soffiati
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D014218:Triage / Q000379:methods*; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D006020:Glycopeptides; D009211:Myoglobin; D019210:Troponin I; C048197:copeptins