Copeptin with high-sensitivity troponin at presentation is not inferior to serial troponin measurements for ruling out acute myocardial infarction

Copeptin with high-sensitivity cardiac troponin to rule out non-ST-elevation myocardial infarction early on: A systematic review and meta-analysis

High-sensitivity cardiac troponin (hs-cTn) with copeptin in rapidly ruling out non-ST-elevation myocardial infarction (NSTEMI) remains controversial. We aimed to evaluate the diagnostic accuracy of this combination compared to hs-cTn alone. A literature search of electronic databases was performed from inception to 26 March 2022. Primary studies that evaluated the diagnostic accuracy of hs-cTn with and without copeptin in patients with NSTEMI were eligible. The reference standard consisted of all available medical results, including a significant rise or fall of cTn with at least one value above the 99th percentile of the reference population. The QUality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the included studies. Thirteen studies involving 8,966 patients, 1,405 of whom were diagnosed with NSTEMI (prevalence, 15.67 %), were included. Combining copeptin with hs-cTn (99th percentile of the healthy population as the threshold) at admission improved the sensitivity from 0.89 to 0.96 (95 % confidence interval [CI] 0.84-0.93 vs 0.93-0.98); the specificity reduced from 0.79 to 0.56 (95 % CI 0.71-0.86 vs 0.51-0.60). In five studies with 6,073 participants (900 NSTEMI), the hs-cTn alone (with 'very low' or limit of detection [LoD] threshold) had higher diagnostic sensitivity than the dual-marker strategy (0.98 vs 0.96). Combining copeptin with hs-cTn (99th percentile of the population as the threshold) at admission improved sensitivity in NSTEMI identification at the expense of specificity. However, with the LoD threshold for hs-cTn, copeptin had no additional value, deterring the widespread use of copeptin if the hs-cTn assay is clinically available.

Copeptin plus troponin in the rapid rule out of acute myocardial infarction and prognostic value on post-myocardial infarction outcomes: a systematic review and diagnostic accuracy study

BACKGROUND

A critical and unmet therapeutic need is the prompt and reliable exclusion of acute myocardial infarction (AMI), which would allow for prompt discharge from the emergency department. High-sensitivity troponin (HS-TnT) combined with copeptin has been proposed to expedite the diagnostic exclusion of AMI in addition to its predictive usefulness in the intermediate and long-term outcomes of AMI. The European Society of Cardiology recommends the Global Registry of Acute Coronary Events (GRACE) as a prognostic score to manage acute coronary syndrome (ACS) without ST segment elevation. The purpose of this study was to compare the diagnostic accuracy of HS-TnT combined with copeptin in ruling out AMI compared to HS-TnT alone. By combining a low GRACE score (108) with negative HS-TnT (14 ng/L) and copeptin (14 pmol/L), non-ST and ACS were reliably ruled out, including non-ST segment elevation MI and unstable angina.

RESULTS

The present research included nine studies with a total of 13,232 participants. The negative predictive value (NPV) for copeptin and HS-TnT was found to be slightly higher in combination (62-99%) than for HS-TnT alone (60-99%). The sensitivity of copeptin ranged from 0% to 100%, with a pooled sensitivity of 0.79 (CI 95% 0.76, 0.82). The specificity of copeptin ranged from 13% to 100%, with a pooled specificity of 0.89 (CI 95% 0.85, 0.91), a pooled positive likelihood ratio (PLR) of 9.86 (CI 95% 4.42, 22.02), and a pooled negative likelihood ratio (NLR) of 0.08. (95% CI 0.01, 0.44).

CONCLUSIONS

The use of combined negative copeptin and highly sensitive troponin testing in low-to-intermediate risk patients with suspected acute coronary syndrome resulted in a quick discharge with a safe and rapid rule out of non-ST + ACS.

The value of Copeptin, myocardial fatty acid-binding protein and myocardial markers in the early diagnosis of acute myocardial infarction

OBJECTIVE

To evaluate and detect the value of Copeptin, myocardial fatty acid binding protein (H-FABP) and myocardial markers in the early diagnosis of acute myocardial infarction (AMI).

METHOD

A retrospective analysis was carried out in 153 patients with chest pain who came to Xianyang Hospital of Yan'an University from August 2019 to April 2022, of whom 87 patients were finally diagnosed with AMI. Cardiac troponin I (cTnI), Copeptin, and H-FABP levels were measured immediately at the patient's visit. Receiver operating characteristic (ROC) curve was drawn to evaluate and compare the value of Copeptin, H-FABP and cTnI in early diagnosis of AMI and their joint effect in improving the accuracy of early diagnosis of AMI.

RESULTS

(1) The levels of Copeptin, H-FABP and cTnI in AMI patients were evidently higher than those in non-AMI patients with chest pain. (2) The diagnostic sensitivity and specificity of Copeptin were 82.89% and 64.37%, respectively. Those of cTnI were 78.95% and 64.37% respectively, and those of H-FABP were 85.53% and 75.86%, respectively. The AUC size under the ROC curve was H-FABP > hopeptin > cTnI. (3) Joint detection of Copeptin, H-FABP and cTnI was better than mono-detection in early diagnosis of AMI.

CONCLUSION

H-FABP has high accuracy in detecting early AMI, which is better than cTnI and Copeptin, but the joint detection of the three is of the highest value.

Copeptin as a Diagnostic and Prognostic Biomarker in Cardiovascular Diseases

Copeptin is the carboxyl-terminus of the arginine vasopressin (AVP) precursor peptide. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis, and regulation of endocrine stress response. Copeptin, which is released in an equimolar mode with AVP from the neurohypophysis, has emerged as a stable and simple-to-measure surrogate marker of AVP and has displayed enormous potential in clinical practice. Cardiovascular disease (CVD) is currently recognized as a primary threat to the health of the population worldwide, and thus, rapid and effective approaches to identify individuals that are at high risk of, or have already developed CVD are required. Copeptin is a diagnostic and prognostic biomarker in CVD, including the rapid rule-out of acute myocardial infarction (AMI), mortality prediction in heart failure (HF), and stroke. This review summarizes and discusses the value of copeptin in the diagnosis, discrimination, and prognosis of CVD (AMI, HF, and stroke), as well as the caveats and prospects for the application of this potential biomarker.

Performance of Copeptin for Early Diagnosis of Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of 14,139 Patients

Diagnosis of acute coronary syndrome (ACS) based on copeptin level may enable one to confirm or rule-out acute myocardial infarction (AMI) with higher sensitivity and specificity, which may in turn further reduce mortality rate and decrease the economic costs of ACS treatment. We conducted a systematic review and meta-analysis to investigate the relationship between copeptin levels and type of ACS. We searched Scopus, PubMed, Web of Science, Embase, and Cochrane to locate all articles published up to 10 October 2021. We evaluated a meta-analysis with random-effects models to evaluate differences in copeptin levels. A total of 14,139 patients (4565 with ACS) were included from twenty-seven studies. Copeptin levels in AMI and non-AMI groups varied and amounted to 68.7 ± 74.7 versus 14.8 ± 19.9 pmol/L (SMD = 2.63; 95% CI: 2.02 to 3.24; p < 0.001). Copeptin levels in the AMI group was higher than in the unstable angina (UAP) group, at 51.9 ± 52.5 versus 12.8 ± 19.7 pmol/L (SMD = 1.53; 95% CI: 0.86 to 2.20; p < 0.001). Copeptin levels in ST-elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (NSTEMI) patient groups were 54.8 ± 53.0 versus 28.7 ± 46.8 pmol/L, respectively (SMD = 1.69; 95% CI: = 0.70 to 4.09; p = 0.17). In summary, elevated copeptin levels were observed in patients with ACS compared with patients without ACS. Given its clinical value, copeptin levels may be included in the assessment of patients with ACS as well as for the initial differentiation of ACS.

Serum exosomal miR-122-5p is a new biomarker for both acute coronary syndrome and underlying coronary artery stenosis

PURPOSE

Acute coronary syndrome presents as unstable angina (UA) or acute myocardial infarction (AMI). We explored the use of exosomal miR-122-5p as a biomarker for UA and AMI and determined whether its expression level is positively correlated with the severity of coronary stenosis.

METHODS

This study enrolled 34 patients with AMI, 31 patients with UA, and 22 control subjects. qPCR was used to detect the expression levels of serum exosomal miR-122-5p.

RESULTS

The expression of serum exosomal miR-122-5p in UA and AMI patients was significantly higher than that in the control group, and expression levels differed between UA and AMI patients. Receiver operating characteristic analysis demonstrated that serum exosomal miR-122-5p might be used as a diagnostic biomarker for AMI and UA. In addition, we also found that serum exosomal miR-122-5p was positively correlated with the severity of coronary artery stenosis for UA patients based on the Gensini score. Serum exosomal miR-122-5p was highly expressed in patients with a coronary artery stenosis severity greater than 80% during acute coronary syndrome.

CONCLUSION

Serum exosomal miR-122-5p might be useful as a diagnostic biomarker for AMI and UA, and increased serum exosomal miR-122-5p levels could be useful to predict the severity of coronary lesions.