Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction.
BACKGROUND
Diabetes is a major risk factor for acute myocardial infarction (AMI). Assessment of diabetic patients is challenging due to an often atypical presentation of symptoms. We aimed to evaluate the two novel biomarkers copeptin and high-sensitive cardiac troponin (hs-TnT) for the improvement of early diagnosis and risk-stratification in patients with diabetes and suspected AMI.


METHODS
In this prospective international multicenter study we evaluated 379 patients with diabetes in a cohort of 1991 patients presenting with symptoms suggestive of AMI. The measurement of biomarkers was performed at presentation.


RESULTS
Among the 379 diabetic patients, 32.7% had AMI, and in the 1621 patients without diabetes, 18.8% had AMI. The additional use of copeptin improved the diagnostic accuracy provided by conventional troponin alone (AUC 0.86 vs. 0.79, p=0.004). During a median follow-up of 814 days, 49 (13.1%) diabetic patients died. Cumulative 2-year survival rate for patients with copeptin levels below 9 pmol/l was 96.6% compared to 82.8% in patients above that level (p<0.001). The same was observed for hs-TnT with a cutoff level of 14 ng/l (97.7% vs. 82.0%, p<0.001) respective of cTnT with a cutoff level of 10 ng/l (93.5% vs. 75.6%, p<0.001). In multivariate Cox analysis, copeptin, hs-TnT and cTnT were strong and independent predictors of 24-month-mortality. Using the dual marker strategy (copeptin and troponin) identified two groups of high-risk patients where 22.5% of the group with hs-cTnT and copeptin above the cutoff and 28.6% with cTnT and copeptin above the cutoff died.


CONCLUSIONS
In diabetic patients, copeptin only slightly improves the early diagnosis of AMI provided by hs-cTnT. However, both markers (copeptin and troponin) predict long-term mortality accurately and independently of each other.
Department of Cardiology, University Hospital Basel, Switzerland.
C
C
Zellweger
Department of Cardiology, University Hospital Basel, Switzerland.
K
K
Wildi
Department of Internal Medicine, University Hospital Basel, Switzerland.
R
R
Twerenbold
Department of Cardiology, University Hospital Basel, Switzerland.
T
T
Reichlin
Department of Cardiology, University Hospital Basel, Switzerland.
A
A
Naduvilekoot
Department of Cardiology, University Hospital Basel, Switzerland.
J D
JD
Neuhaus
Department of Internal Medicine, University Hospital Basel, Switzerland.
C
C
Balmelli
Department of Cardiology, University Hospital Basel, Switzerland.
M
M
Gabutti
Department of Cardiology, King Saud Medical City, Tanta University, Riyadh, Saudi Arabia.
A
A
Al Afify
Emergency Department, San Martino Hospital, Genova, Italy.
P
P
Ballarino
Department of Cardiology, University Hospital Basel, Switzerland.
C
C
Jäger
Department of Cardiology, University Hospital Basel, Switzerland.
S
S
Druey
Department of Cardiology, University Hospital Basel, Switzerland.
P
P
Hillinger
Department of Cardiology, University Hospital Basel, Switzerland.
P
P
Haaf
Servicio de Laboratorios, Hospital del Mar-IMIM, Barcelona, Spain.
C
C
Vilaplana
Brahms Thermo Fisher, Hennigsdorf, Germany.
B
B
Darbouret
Brahms Thermo Fisher, Hennigsdorf, Germany.
S
S
Ebmeyer
Department of Cardiology, University Hospital Basel, Switzerland.
M
M
Rubini Gimenez
Department of Cardiology, University Hospital Basel, Switzerland.
B
B
Moehring
Department of Cardiology, University Hospital Basel, Switzerland.
S
S
Osswald
Department of Cardiology, University Hospital Basel, Switzerland. Electronic address: muellerch@uhbs.ch.
C
C
Mueller
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins
Acute myocardial infarction; Conventional cardiac troponin; Copeptin; Diabetes; High sensitive cardiac troponin