เปรียบเทียบระหว่างการใช้โคเปปตินร่วมกับโทรโปนินที กับการใช้โทรโปนินทีอย่างเดียว เพื่อช่วยประเมินการเกิดโรคกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิดไม่มีเอสทีเซกเมนท์ยก ภายใน 12 ชั่วโมงหลังมีอาการ / ชญานุตม์ สุวรรณเพ็ญ = Comparison study of using copeptin ontop troponint in diagnosis of non-st elevation myocardial infarction (nstemi) within 12 hours after onset of chest pain / Chayanute Suwanpen
Objectives: To study the values of new biomarker, copeptin - the C-terminal part of the vasopressin prohormone, adding to troponinT (using highly sensitive cardiac troponinT – hs cTnT) for early diagnosis of non-ST elevation myocardial infarction (NSTEMI) in patients suspected of acute cardiac chest pain within 12 hours onset and the values of copeptin in short term prognosis after acute NSTEMI event. Background: Diagnosis of NSTEMI in acute chest pain patients without persistent ST segment elevation is challenging due to the false negativity or low normal results of specific cardiac biomarker in the early onset of symptoms. Copeptin, a nonspecific biomarker, in combination with inital troponinT may be useful for early concern in the diagnosis due to rapid rising property. Furthermore, copeptin maybe a prognostic index of cardiovascular outcomes after NSTEMI. Methods: From August through December 2011, 45 consecutive patients with acute chest pain within 12 hours of symptom onset suspected of acute coronary syndrome (ACS) without persistent ST-segment elevation were measured the copeptin levels, by blinded sandwich electrochemiluminescence immunoassay, adding to standard evaluation in ACS including initial level of hs cTnT. The final diagnosis was determined by 2 independent cardiologists. Short term cardiovascular outcomes (death from cardiovascular event, myocardial infarction, stroke, heart failure) were evaluated after 1 month of NSTEMI event. Results: Thirty-three patients (73%) were diagnosed as NSTEMI and 12 patients (27%) were not NSTEMI (non cardiac chest pain and unstable angina). NSTEMI patients had higher level of copeptin than remaining patients [median (min-max) = 11.0 (2.8-954.3) vs 7.5 (2.5-41.8) pmol/L, p = 0.40]. The interpretation used copeptin adding to hs cTnT at initial presentation within 12-hour of chest pain onset resulted in equal sensitivity (97.0%) compared to only hs cTnT for diagnosis of NSTEMI. Specificity and negative predictive value (NPV) decreased from 58.3% to 41.7% and from 87.5% to 83.3%, respectively. Area under curve of the ROC of copeptin adding to hs cTnT was lower than that of only hs cTnT [0.59 (0.39-0.79) vs 0.94 (0.88-1.00), p<0.05]. For patients presented within 6 and 3 hours, area under curve of the ROC of copeptin adding to hs cTnT was also lower than that of only hs cTnT significantly [0.56 (0.33-0.77) vs 0.93 (0.86-1.00), p<0.05 and 0.58 (0.31-0.81) vs 0.92 (0.80-1.00), p<0.05 in chest pain onset within 6 and 3 hours respectively]. The early cardiovascular complications had no significant difference between positive and negative results of copeptin level (p = 0.50) in NSTEMI group. Conclusions: Our study showed that combination of copeptin and initial hs cTnT did not increase diagnostic consideration for NSTEMI in early onset, less than 12 hours, of chest pain patients compared to only hs cTnT. Furthermore, no prognostic value of copeptin in short term cardiovascular outcomes observed during 1 month after NSTEMI event.
