Copeptin testing in acute myocardial infarction: ready for routine use?

Abstract

Suspected acute myocardial infarction is one of the leading causes of admission to emergency departments. In the last decade, biomarkers revolutionized the management of patients with suspected acute coronary syndromes. Besides their pivotal assistance in timely diagnosis, biomarkers provide additional information for risk stratification. Cardiac troponins I and T are the most sensitive and specific markers of acute myocardial injury. Nonetheless, in order to overcome the remaining limitations of these markers, novel candidate biomarkers sensitive to early stage of disease are being extensively investigated. Among them, copeptin, a stable peptide derived from the precursor of vasopressin, emerged as a promising biomarker for the evaluation of suspected acute myocardial infarction. In this review, we summarize the currently available evidence for the usefulness of copeptin in the diagnosis and risk stratification of patients with suspected acute myocardial infarction in comparison with routine biomarkers.

Figure 1

Distribution pattern of copeptin in patients with chest pain admitted to the emergency department (n = 171) according to discharge diagnosis. Our own unpublished data are shown as box plots. AMI patients were divided by delay from symptom onset. Copeptin concentrations in AMI patients presenting within 14 h from symptom onset were significantly (P = 0.013) higher than in the remaining patients, whereas AMI patients presenting thereafter did not differ significantly. Abbreviations—AMI: acute myocardial infarction.

Figure 2

ROC analysis to compare the diagnostic power of copeptin, hs-cTnT, and the combination of both for the diagnosis of AMI in patients presenting with chest pain early after symptom onset (within 14 hours) on admission. Own unpublished data. The AUC of hs-cTnT (0.90, 95% confidence interval 0.79–0.97) did not differ significantly from the AUC of copeptin combined with hs-cTnT (0.94, 95% confidence interval 0.84–0.99; P > 0.05). Abbreviations—ROC: receiver operating characteristic; hs-cTnT: high-sensitivity cardiac troponin T; AMI: acute myocardial infarction; AUC: area under the curve.