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Shi Z, Qian C. Copeptin and the prognosis of patients with coronary artery disease: a meta-analysis. Ir J Med Sci 2023; 192:2129-2141. [PMID: 36719516 DOI: 10.1007/s11845-023-03276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Copeptin, the C-terminal portion of provasopressin, has been regarded as a marker of non-specific stress response and a potentially prognostic biomarker of cardiovascular diseases. This systematic review and meta-analysis was conducted to summarize the predictive role of baseline copeptin for the prognosis of patients with coronary artery disease (CAD). METHODS Relevant observational studies with longitudinal follow-up were obtained by comprehensive search of PubMed, Embase, and Web of Science databases. A random-effects model was used to pool the results. RESULTS Twenty-two studies with 19,821 patients with CAD were enrolled. Results of the meta-analyses revealed that a high copeptin at baseline was associated with a higher mortality risk (risk ratio [RR]: 1.76, 95% confidence interval [CI]: 1.49 to 2.09, p < 0.001; I2 = 70%) and an increased incidence of major adverse cardiovascular events (MACEs, RR: 1.49, 95% CI: 1.34 to 1.65, p < 0.001; I2 = 28%) in patients with CAD. Further results of sensitivity and subgroup analyses showed consistent associations between high copeptin with increased risks of mortality and MACEs in studies of patients with different ages, proportion of men, subtypes of CAD, study design, follow-up durations, and quality scores (p for subgroup effect all < 0.05). CONCLUSIONS A high plasma level of copeptin is associated with higher risks of mortality and MACEs in patients with CAD. Measuring copeptin may be helpful for risk stratification in patients with CAD.
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Affiliation(s)
- Zhewei Shi
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, 311800, China.
| | - Caizhen Qian
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, 311800, China
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Al‐Atta A, Spray L, Mohammed A, Shmeleva E, Spyridopoulos I. Arginine Vasopressin Plays a Role in Microvascular Dysfunction After ST-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e030473. [PMID: 37681545 PMCID: PMC10547306 DOI: 10.1161/jaha.123.030473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
Background Coronary microvascular dysfunction (CMD) predicts mortality after ST-elevation-myocardial infarction (STEMI). Arginine vasopressin (AVP) may be implicated, but data in humans are lacking, and no study has investigated the link between arginine vasopressin and invasive measures of CMD. Methods and Results We invasively assessed CMD in 55 patients with STEMI treated with primary percutaneous coronary intervention (PPCI), by measuring the index of microcirculatory resistance after PPCI. In a separate group of 45 patients with STEMI/PPCI, recruited for a clinical trial, we measured infarct size and microvascular obstruction with cardiac magnetic resonance (CMR) imaging at 1 week and 12 weeks post-STEMI. Serum copeptin was measured at 4 time points before and after PPCI in all patients with STEMI. Plasma copeptin levels fell from 92.5 pmol/L before reperfusion to 6.4 pmol/L at 24 hours. Copeptin inversely correlated with diastolic, but not systolic, blood pressure (r=-0.431, P=0.001), suggesting it is released in response to myocardial ischemia. Persistently raised copeptin at 24 hours was correlated with higher index of microcirculatory resistance (r=0.372, P=0.011). Patients with microvascular obstruction on early CMR imaging showed a trend toward higher admission copeptin, which was not statistically significant. Copeptin levels were not associated with infarct size on either early or late CMR. Conclusions Patients with CMD after STEMI have persistently elevated copeptin at 24 hours, suggesting arginine vasopressin may contribute to microvascular dysfunction. Arginine vasopressin receptor antagonists may represent a novel therapeutic option in patients with STEMI and CMD.
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Affiliation(s)
- Ayman Al‐Atta
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
| | - Luke Spray
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
| | | | | | - Ioakim Spyridopoulos
- Freeman HospitalNewcastle upon TyneUnited Kingdom
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUnited Kingdom
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Biomarkers Utility: At the Borderline between Cardiology and Neurology. J Cardiovasc Dev Dis 2021; 8:jcdd8110139. [PMID: 34821692 PMCID: PMC8621331 DOI: 10.3390/jcdd8110139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
Biomarkers are important diagnostic and prognostic tools as they provide results in a short time while still being an inexpensive, reproducible and accessible method. Their well-known benefits have placed them at the forefront of research in recent years, with new and innovative discoveries being implemented. Cardiovascular and neurological diseases often share common risk factors and pathological pathways which may play an important role in the use and interpretation of biomarkers' values. Among the biomarkers used extensively in clinical practice in cardiology, hs-TroponinT, CK-MB and NTproBNP have been shown to be strongly influenced by multiple neurological conditions. Newer ones such as galectin-3, lysophosphatidylcholine, copeptin, sST2, S100B, myeloperoxidase and GDF-15 have been extensively studied in recent years as alternatives with an increased sensitivity for cardiovascular diseases, but also with significant results in the field of neurology. Thus, given their low specificity, the values interpretation must be correlated with the clinical judgment and other available investigations.
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Mueller M, Beitzke D, Scherz T, Loewe C, Mangold A, Marculescu R, Poppe M, Sterz F, Herkner H, Lang I, Testori C, Weiser C. Copeptin Levels Are Independent from Mild Therapeutic Hypothermia but Do Not Predict Infarct Size in Patients Presenting with ST-Segment Elevation Myocardial Infarction. J Cardiovasc Dev Dis 2021; 8:jcdd8100131. [PMID: 34677200 PMCID: PMC8539262 DOI: 10.3390/jcdd8100131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Mild therapeutic hypothermia (MTH) is a treatment adjunct in ST-segment elevation myocardial infarction (STEMI) that deserves investigation. Copeptin―a surrogate marker for vasopressin―is an early biomarker in STEMI. Data from cardiac arrest patients suggest a reduction of copeptin levels through MTH; however, copeptin levels have not been investigated in MTH during STEMI. Methods: We analyzed patients treated with MTH during STEMI in a sub-study of the STATIM trial (Testori, Heart 2019). Patients were randomized to normothermia or MTH with out-of-hospital initiation. Seven copeptin samples were collected from each patient. Primary endpoint was the difference in copeptin levels between the groups. As secondary endpoints, we defined differences in the kinetics between the sampling timepoints and the correlation between copeptin and the infarct size in relation to left ventricular myocardium. Results: We included 99 patients (MTH n = 47, control n = 52) in our intention to treat analysis. No differences in copeptin values at first medical contact between the MTH and normothermia groups were found. MTH showed no effect on copeptin levels, neither during cooling phase nor through the course. Copeptin peaked at first medical contact and hospital admission in both groups. No differences in kinetics between the timepoints were found. Copeptin showed no correlation with infarct size, neither at first medical contact nor hospital admission. Conclusions: Copeptin levels were not influenced by MTH in STEMI, suggesting the use of this biomarker also during temperature management. Furthermore, copeptin levels were not usable as a surrogate marker for infarct size at any timepoint.
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Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Thomas Scherz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Andreas Mangold
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
- Correspondence: ; Tel.: +43-40-400-19640; Fax: +43-40-400-19650
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
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Waldsperger H, Biener M, Stoyanov KM, Vafaie M, Katus HA, Giannitsis E, Mueller-Hennessen M. Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study. J Clin Med 2020; 9:E3627. [PMID: 33187192 PMCID: PMC7696893 DOI: 10.3390/jcm9113627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS We aimed to assess the prognostic role of copeptin in patients presenting to the emergency department with acute symptoms and increased high-sensitivity cardiac troponin T. METHODS A total of 3890 patients presenting with acute symptoms to the emergency department of Heidelberg University Hospital were assessed for increased hs-cTnT (>14 ng/L) from three cohorts: the Heidelberg Acute Coronary Syndrome (ACS) Registry (n = 2477), the BIOPS Registry (n = 320), and the ACS OMICS Registry (n = 1093). In a pooled analysis, 1956 patients remained, comprising of 1600 patients with ACS and 356 patients with non-ACS. RESULTS Median follow-up was 1468 days in the ACS cohort and 709 days in the non-ACS cohort. Elevated copeptin levels (>10 pmol/L) were found in 1174 patients (60.0%) in the entire cohort (58.1% in ACS and 68.5% in non-ACS, respectively) and mortality rates were significantly higher than in patients with normal copeptin levels (29.0% vs. 10.7%, p < 0.001). In a multivariate Cox regression, elevated copeptin was independently associated with all-cause death in the ACS (HR = 1.7, 1.3-2.3, p = 0.002) and non-ACS cohort (HR = 2.7, 1.4-5.0, p = 0.0018). CONCLUSION Copeptin may aid in identifying patients at risk for adverse outcomes in patients with increased levels of hs-cTnT in ACS patients and in non-ACS conditions.
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Affiliation(s)
- Hanna Waldsperger
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
| | - Moritz Biener
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Kiril M. Stoyanov
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
| | - Mehrshad Vafaie
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
| | - Hugo A. Katus
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
| | - Matthias Mueller-Hennessen
- Department of Internal Medicine III, Heidelberg University Hospital, 69120 Heidelberg, Germany; (H.W.); (M.B.); (K.M.S.); (M.V.); (H.A.K.); (E.G.)
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, 69120 Heidelberg, Germany
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Doganay B, Okutucu S, Cetin M, Kızıltunc E, Karayigit O, Ozkan C, Kılınckaya MF, Ornek E. Association of Serum Copeptin Levels with Patency of Infarct-Related Arteries in Patients with ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2019; 35:360-368. [PMID: 31371896 DOI: 10.6515/acs.201907_35(4).20181101a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Copeptin is widely used as a predictor of an adverse prognosis in many clinical conditions. Reduced antegrade coronary flow in an infarct-related artery (IRA) is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate whether copeptin level on admission was associated with IRA patency in STEMI patients. Methods A total of 88 patients were enrolled into the study and divided into two groups according to TIMI flow grade in the IRA before primary percutaneous coronary intervention. Results White blood cell count (p = 0.015), neutrophils (p = 0.047), N-terminal pro-brain natriuretic peptide (NTproBNP) (p < 0.001), copeptin (p < 0.001) and peak troponin I (p = 0.001) were significantly higher in the occluded IRA group with a significantly lower serum sodium level (p < 0.001). Age- and gender-adjusted multivariate analysis revealed that copeptin (OR = 1.970; p = 0.001), peak troponin I (1.055; p = 0.005) and NTproBNP (OR = 1.003; p = 0.010) were independent predictors of an occluded IRA. A copeptin cut-off value of > 6.8 ng/mL was found to predict an occluded IRA with a sensitivity of 80% and specificity of 100% (area under the curve: 0.917; p < 0.001). Performance ranking of the biomarkers that could predict an occluded IRA showed copeptin > peak troponin I = NTproBNP. Conclusions Copeptin levels were higher in the patients with an occluded IRA and STEMI. Higher levels of copeptin predicted an occluded IRA in the patients with STEMI who were admitted to the emergency department during the first three hours of chest pain.
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Affiliation(s)
- Birsen Doganay
- Department of Cardiology, Numune Education and Research Hospital
| | | | - Mustafa Cetin
- Department of Cardiology, Numune Education and Research Hospital
| | | | - Orhan Karayigit
- Department of Cardiology, Numune Education and Research Hospital
| | - Can Ozkan
- Department of Cardiology, Numune Education and Research Hospital
| | | | - Ender Ornek
- Department of Cardiology, Numune Education and Research Hospital
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Lattuca B, Sy V, Nguyen LS, Bernard M, Zeitouni M, Overtchouk P, Yan Y, Hammoudi N, Ceccaldi A, Collet JP, Kerneis M, Diallo A, Montalescot G, Silvain J. Copeptin as a prognostic biomarker in acute myocardial infarction. Int J Cardiol 2018; 274:337-341. [PMID: 30217427 DOI: 10.1016/j.ijcard.2018.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Copeptin - the C-terminal section of vasopressin precursor - is a novel biomarker, that has been shown to be a useful prognostic factor in heart failure, ischemic stroke and in acute myocardial infarction (MI) but with restricted population and follow-up in ST-segment elevation MI (STEMI) setting. We evaluated in this study the hypothesis that copeptin measured on admission is an independent predictor of one-year all-cause mortality after a STEMI. METHODS Copeptin was measured immediately on arrival in the catheterization laboratory in a cohort of unselected STEMI patients and was compared to the peak of cardiac troponin I as a prognosis marker. One-year follow-up was performed. RESULTS We included 401 STEMI patients (77% of men, mean age 64 ± 14 years) treated by primary percutaneous coronary intervention. Copeptin on admission was significantly higher in patients who died during the one-year follow-up than in survivors (154.8 pmol/L; IQR [63.9-304.8] vs 30.3 pmol/L; IQR [10.8-93.5]); p < 0.0001). There was an increase in mortality at one year from the lowest to the highest quartile of copeptin. After Cox regression analysis, copeptin was an independent predictor of death at one year (adjHR 3.1, 95% CI [1.5-6.2], p = 0.001). When compared to the peak value of cardiac troponin I, copeptin measured on admission had a better prognostic value to predict one-year mortality (AUC of 0.74 vs 0.60, p = 0.022). CONCLUSION Copeptin measured on admission is a reliable and independent prognostic biomarker of one-year mortality in acute myocardial infarction patients.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France.
| | - Vuthy Sy
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Lee S Nguyen
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Maguy Bernard
- Sorbonne University - Paris 06 (UPMC), Biochemistry Department, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France.
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Pavel Overtchouk
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Yan Yan
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Alexandre Ceccaldi
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Abdourahmane Diallo
- ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisiere University Hospital, Paris, France.
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, Paris, France.
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Árnadóttir Á, Schoos M, Lønborg J, Ahtarovski K, Kelbæk H, Helqvist S, Høfsten D, Clemmensen P, Engstrøm T, Nepper-Christensen L, Vejlstrup N, Køber L, Iversen K. Can copeptin and troponin T ratio predict final infarct size and myocardial salvage index in patients with ST-elevation myocardial infarction: A sub-study of the DANAMI-3 trial. Clin Biochem 2018; 59:37-42. [PMID: 29932892 DOI: 10.1016/j.clinbiochem.2018.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (pPCI) is recommended in patients presenting with ST-elevation myocardial infarction (STEMI) within <12 h of symptom onset. However, patients-reported symptom duration is not always reliable. Cardiac specific troponin T (cTnT) and the endogenous stress marker copeptin have different temporal release patterns for myocardial infarction MI. We hypothesized that copeptin/troponin-ratio is associated to the duration of coronary occlusion and therefore inversely proportional to myocardial salvage. METHOD Patients older than 18 years with first time STEMI referred to pPCI were eligible. cTnT and copeptin values were measured at admission. A cardiac magnetic resonance scanning (CMR) was done during the index admission for assessment of area at risk (AAR), and later 3 months to assess final infarct size (FIS). Myocardial salvage index (MSI) was calculated based on these measurements. RESULTS A total of 468 patients were included. The median time from patient-reported onset of symptoms to pPCI was 192 min (IQR 150 min - 290 min). At presentation 416 (89%) patients had hs-cTnT values above the 99th percentile, median hs-cTnT was 53 ng/l (IQR 24 ng/l-146 ng/l) and 318 (68%) patients had copeptin values above the 99th percentile (18.9 pmol/l), median copeptin was 50 pmol/l (IQR 14 pmol/l-131 pmol/l). Symptom duration showed a weak but significant association with AAR (R2 = 0.02, p = .04), FIS (R2 = 0.03, p < .01) and MSI (R2 = 0.04, p < .01). Copeptin/troponin-ratio was significantly associated with symptom duration (R2 = 0.19, p < .01), but not AAR (R2 = 0.02, p = .19), FIS (R2 = 0.02, p = .12), or MSI (R2 = 0.01, p = .25). CONCLUSION Copeptin/troponin-ratio is associated with patient-reported symptom duration, but there was no association with area at risk, final infarct size or myocardial salvage index.
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Affiliation(s)
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany; Department of Medicine, Division of Cardiology, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
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Copeptin as a Prognostic Marker in Acute Chest Pain and Suspected Acute Coronary Syndrome. DISEASE MARKERS 2018; 2018:6597387. [PMID: 29619130 PMCID: PMC5829365 DOI: 10.1155/2018/6597387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/25/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
Background In patients admitted with chest pain and suspected acute coronary syndrome (ACS), it is crucial to early identify those who are at higher risk of adverse events. The study aim was to assess the predictive value of copeptin in patients admitted to the emergency department with chest pain and nonconclusive ECG. Methods Consecutive patients suspected for an ACS were enrolled prospectively. Copeptin and high-sensitive troponin T (hs-TnT) were measured at admission. Patients were followed up at six and 12 months for the occurrence of death and major adverse cardiac and cerebrovascular events (MACCE). Results Among 154 patients, 11 patients died and 26 experienced MACCE. Mortality was higher in copeptin-positive than copeptin-negative patients with no difference in the rate of MACCE. Copeptin reached the AUC 0.86 (0.75–0.97) for prognosis of mortality at six and 0.77 (0.65–0.88) at 12 months. It was higher than for hs-TnT and their combination at both time points. Copeptin was a strong predictor of mortality in the Cox analysis (HR14.1 at six and HR4.3 at 12 months). Conclusions Copeptin appears to be an independent predictor of long-term mortality in a selected population of patients suspected for an ACS. The study registration number is ISRCTN14112941.
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Mueller C, Möckel M, Giannitsis E, Huber K, Mair J, Plebani M, Thygesen K, Jaffe AS, Lindahl B. Use of copeptin for rapid rule-out of acute myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:570-576. [PMID: 28593800 DOI: 10.1177/2048872617710791] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care. However, the dual-marker approach seems to provide only very small incremental value when used in combination with sensitive or high-sensitivity cardiac troponin assays. This review aims to update and educate regarding the potential and the procedural details, as well as the caveats and challenges of using copeptin in clinical practice.
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Affiliation(s)
- Christian Mueller
- 1 Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Martin Möckel
- 2 Division of Emergency Medicine, Charite, Universitätsmedizin Berlin, Germany
| | | | - Kurt Huber
- 4 Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Johannes Mair
- 5 Department of Internal Medicine III - Cardiology and Angiology, Innsbruck Medical University, Austria
| | - Mario Plebani
- 6 Department of Laboratory Medicine, University Hospital, Padova, Italy
| | | | | | - Bertil Lindahl
- 9 Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Centre, Uppsala University, Sweden
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Reindl M, Reinstadler SJ, Feistritzer HJ, Niess L, Koch C, Mayr A, Klug G, Metzler B. Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction. Int J Cardiol 2017; 241:76-82. [PMID: 28499665 DOI: 10.1016/j.ijcard.2017.03.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/19/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Persistent T-wave inversion (PTI) after ST-elevation myocardial infarction (STEMI) is associated with worse clinical outcome; however, the underlying mechanism between PTI and poor prognosis is incompletely understood. We sought to investigate the relationship between PTI and myocardial damage assessed by cardiac magnetic resonance (CMR) following STEMI. METHODS In this prospective observational study, we included 142 consecutive revascularized STEMI patients. Electrocardiography to determine the presence and amplitude of PTI and pathological Q-waves was conducted 4months after infarction. CMR was performed within 1week after infarction and at 4months follow-up to evaluate infarct characteristics and myocardial function. RESULTS Patients with PTI (n=103, 73%) showed a larger acute (21[11-29] vs. 6[1-13]%; p<0.001) and chronic infarct size (IS) (14[8-19] vs. 3[1-8]%; p<0.001) and more frequently microvascular obstruction (59 vs. 33%; p=0.02). The association between PTI and chronic IS remained significant (odds ratio: 9.02, 95%CI 3.49-23.35; p<0.001) after adjustment for pathological Q-wave and other IS estimators (high-sensitivity cardiac troponin T and C-reactive protein, N-terminal pro B-type natriuretic peptide, culprit vessel, pre-interventional TIMI flow). The value of PTI amplitude for the prediction of large chronic IS>11% (AUC: 0.84, 95%CI 0.77-0.90) was significantly higher compared to Q-wave amplitude (AUC: 0.72, 95%CI 0.63-0.80; p=0.009); the combination of PTI with pathological Q-wave (Q-wave/T-wave score) led to a net reclassification improvement of 0.43 (95% CI 0.29-0.57; p<0.001) as compared to PTI alone. CONCLUSIONS PTI following STEMI is independently and incrementally associated with more extensive myocardial damage as visualized by CMR. An electrocardiographic score combining PTI with pathological Q-wave allows for a highly accurate IS estimation post-STEMI.
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Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Lea Niess
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Constantin Koch
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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