Ann Lab Med 2020; 40(1): 7-14  https://doi.org/10.3343/alm.2020.40.1.7
Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting
Ji Hun Jeong, M.D., Ph.D.1, Yiel Hea Seo, M.D., Ph.D.2, Jeong Yeal Ahn, M.D., Ph.D.2, Kyung Hee Kim, M.D., Ph.D.2, Ja Young Seo, M.D., Ph.D.2, Ka Yeong Chun, M.D.3, Yong Su Lim, M.D., Ph.D.4, and Pil Whan Park, M.D., Ph.D.2
1Department of Laboratory Medicine, Chung Ang University Hospital, Seoul, Korea; 2Department of Laboratory Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea; 3Department of Internal Medicine, Gimpo Woori Hospital, Gimpo, Korea; 4Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
Corresponding author: Pil Whan Park, M.D., Ph.D.
Department of Laboratory Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-460-3834 Fax: +82-32-460-3415 E-mail: pwpark@gilhospital.com
Received: April 19, 2019; Revised: April 22, 2019; Accepted: August 7, 2019; Published online: January 1, 2020.
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Abstract
Background: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI).
Methods: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed.
Results: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients.
Conclusions: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.
Keywords: Acute myocardial infarction, Copeptin, Troponin I, Creatine kinase myocardial band, Performance, ST elevation myocardial infarction, Non-ST elevation myocardial infarction



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