Comparison of Troponin, High-Sensitivity Troponin, and Copeptin Markers at Different Times in Patients with High-Risk Chest Pain

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Emergency Medicine, School of Medicine AND Emergency Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Pathologist, Department of Pathology, School of Medicine AND Clinical Medical Laboratory, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

5 PhD Student, Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The incidence of cases with acute myocardial infarction (AMI) and patients suffering from chest pain (CP) referred to emergency departments are increasing. Therefore, finding a marker that can help faster diagnose of the disease can have beneficial effects for patients. This study compared troponin, high-sensitivity troponin, and copeptin markers at different times in patients with high-risk chest pain.Methods: This study was performed on 90 emergency care patients with high-risk chest pain, as the first symptom of myocardial infarction (MI), in educational hospitals in Isfahan City, Iran. Demographic and clinical data including the levels of troponin, high-Sensitivity troponin, and copeptin markers were collected and evaluated at the time of arrival, and 2 and 6 hours later.Findings: The mean age of patients with high-risk chest pain was 60.73 ± 1.23 years, of which 57 (63.3%) were men. There were significant differences between the frequency of three markers at arrival (P = 0.0004) and 2 hours (P = 0.0009) later. Nevertheless, after 6 hours, the results did not show any significant difference (P > 0.0010).Conclusion: Repeated measurement of copeptin leads to a more successful AMI prevention compared to troponin and high-sensitivity troponin markers.

Keywords


  1. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007; 28(13): 1598-660.
  2. Robert JJ, Blide RW, McWhorter K, Coursey C. The effects of a work hardening program on cardiovascular fitness and muscular strength. Spine (Phila Pa 1976) 1995; 20(10): 1187-93.
  3. Xu RY, Zhu XF, Yang Y, Ye P. High-sensitive cardiac troponin T. J Geriatr Cardiol 2013; 10(1): 102-9.
  4. Lipinski MJ, Baker NC, Escarcega RO, Torguson R, Chen F, Aldous SJ, et al. Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis. Am Heart J 2015; 169(1): 6-16.
  5. Mockel M. Copeptin adds to high-sensitivity troponin T in rapid rule out of acute myocardial infarction. Clin Chem 2012; 58(1): 306-7.
  6. Eggers KM, Venge P, Lindahl B. High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain. Clin Chim Acta 2012; 413(13-14): 1135-40.
  7. Mockel M, Searle J, Hamm C, Slagman A, Blankenberg S, Huber K, et al. Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): A randomized, controlled clinical process study. Eur Heart J 2015; 36(6): 369-76.
  8. Robertson GL, Mahr EA, Athar S, Sinha T. Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest 1973; 52(9): 2340-52.
  9. Morgenthaler NG, Struck J, Alonso C, Bergmann A. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem 2006; 52(1): 112-9.
  10. Khan SQ, Dhillon OS, O'Brien RJ, Struck J, Quinn PA, Morgenthaler NG, et al. C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) study. Circulation 2007; 115(16): 2103-10.
  11. Keller T, Tzikas S, Zeller T, Czyz E, Lillpopp L, Ojeda FM, et al. Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol 2010; 55(19): 2096-106.
  12. Voors AA, von HS, Anker SD, Hillege HL, Struck J, Hartmann O, et al. C-terminal provasopressin (copeptin) is a strong prognostic marker in patients with heart failure after an acute myocardial infarction: results from the OPTIMAAL study. Eur Heart J 2009; 30(10): 1187-94.
  13. Stoiser B, Mortl D, Hulsmann M, Berger R, Struck J, Morgenthaler NG, et al. Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure. Eur J Clin Invest 2006; 36(11): 771-8.
  14. Reichlin T, Hochholzer W, Stelzig C, Laule K, Freidank H, Morgenthaler NG, et al. Incremental value of copeptin for rapid rule out of acute myocardial infarction. J Am Coll Cardiol 2009; 54(1): 60-8.
  15. Meune C, Zuily S, Wahbi K, Claessens YE, Weber S, Chenevier-Gobeaux C. Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: A pilot study. Arch Cardiovasc Dis 2011; 104(1): 4-10.
  16. Elshafei A, Abdallah G, Abd El-Motaal O, Salman T. Copeptin: A neuroendocrine biomarker in acute myocardial infarction. Annu Res Rev Biol 3(4): 1040-54.
  17. Mockel M, Searle J. Copeptinmarker of acute myocardial infarction. Curr Atheroscler Rep 2014; 16(7): 421.
  18. Charpentier S, Maupas-Schwalm F, Cournot M, Elbaz M, Botella JM, Lauque D. Combination of copeptin and troponin assays to rapidly rule out non-ST elevation myocardial infarction in the emergency department. Acad Emerg Med 2012; 19(5): 517-24.
  19. Maisel A, Mueller C, Neath SX, Christenson RH, Morgenthaler NG, McCord J, et al. Copeptin helps in the early detection of patients with acute myocardial infarction: Primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol 2013; 62(2): 150-60.
  20. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Jr., et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007; 50(7): e1-e157.
  21. Wu AH. Early detection of acute coronary syndromes and risk stratification by multimarker analysis. Biomark Med 2007; 1(1): 45-57.
  22. Peacock WF, Baumann BM, Bruton D, Davis TE, Handy B, Jones CW, et al. Efficacy of high-sensitivity troponin t in identifying very-low-risk patients with possible acute coronary syndrome. JAMA Cardiol 2018; 3(2): 104-11.