Piyanuttapull Sumitra
Department of Emergency Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2013 Jan;96(1):13-9.
Patients present with chest pain. Electrocardiography (ECG) is used and troponin-T levels slowly increases. Diagnosis of myocardial infarction requires prolonged monitoring, over six to nine hours, for serial blood sampling. It is the cause of delayed treatment and lead to a crowded emergency room. Troponin is a marker of myocardial necrosis, the gold standard in detection of acute myocardial infarction (AMI). Copeptin, the C-terminal part ofthe vasopressin prohormone, as a marker of acute endogenous stress, adds diagnosis information to cardiac troponin in early evaluation ofpatients with suspected myocardial infarction.
To determine the correlation between plasma copeptin level and troponin-T It is also to determine if the copeptin level can be used as early diagnosis in patients who present with chest pain and are suspected to be acute myocardial infarction (AMI).
Patients with chest pain that presented to the emergency department ofRajavithi Hospital between October 2010 and October 2011 and were suspected to have myocardial infarction were consecutively enrolled in thepresent study. The level ofplasma copeptin and troponin-T were measured at presentation and six hours after presentation.
One hundred fifty patients presented to the emergency department with chest pain. Their average age was 66.71+/-7.78 years. The mean plasma copeptin level was 13.91+/-5.01 pmol/l in acute myocardial infarction. Plasma copeptin level increased compared with troponin-T Plasma copeptin level increased and correlated with troponin-T to diagnose myocardial infarction (r = 0.317) at presentation. It further increased and correlated (r = 0.562) at six hours after presentation. Plasma copeptin levels for diagnosis of ST elevate myocardial infarction (STEMI) at presentation have an area under curve (AUC) = 0.91, p<0.001, sensitivity 90.9%, and specificity 87.8%. The non-ST elevated myocardial infarction (NSTEMI) have an area under curve (AUC) = 0.71, p<0.001, sensitivity 88.8%, specificity 69.8%, and cut-off point of 10.25 pmol/l.
Plasma copeptin can be used for early diagnosis of myocardial infarction. The additional use of copeptin to Troponin-T allows for a rapid triage of chest pain patients to an early diagnosis of non-ST elevation myocardial infarction.
患者出现胸痛症状。使用了心电图（ECG）检查，肌钙蛋白-T水平缓慢升高。心肌梗死的诊断需要长达六至九个小时的长时间监测，以便进行系列血液采样。这导致了治疗延迟，并造成急诊室拥挤。肌钙蛋白是心肌坏死的标志物，是检测急性心肌梗死（AMI）的金标准。copeptin作为血管加压素原激素的C末端部分，作为急性内源性应激的标志物，在对疑似心肌梗死患者的早期评估中为心肌肌钙蛋白增加了诊断信息。
确定血浆copeptin水平与肌钙蛋白-T之间的相关性。还要确定copeptin水平是否可用于对出现胸痛且疑似急性心肌梗死（AMI）的患者进行早期诊断。
2010年10月至2011年10月期间到拉贾维蒂医院急诊科就诊且疑似心肌梗死的胸痛患者连续纳入本研究。在就诊时和就诊后六小时测量血浆copeptin和肌钙蛋白-T水平。
150例患者因胸痛到急诊科就诊。他们的平均年龄为66.71±7.78岁。急性心肌梗死患者的平均血浆copeptin水平为13.91±5.01 pmol/l。与肌钙蛋白-T相比，血浆copeptin水平升高。就诊时血浆copeptin水平升高并与肌钙蛋白-T相关（r = 0.317）以诊断心肌梗死。就诊后六小时进一步升高并相关（r = 0.562）。就诊时用于诊断ST段抬高型心肌梗死（STEMI）的血浆copeptin水平曲线下面积（AUC）= 0.91，p<0.001，敏感性90.9%，特异性87.8%。非ST段抬高型心肌梗死（NSTEMI）的曲线下面积（AUC）= 0.71，p<0.001，敏感性88.8%，特异性69.8%，截断点为10.25 pmol/l。
血浆copeptin可用于心肌梗死的早期诊断。将copeptin与肌钙蛋白-T联合使用可对胸痛患者进行快速分诊，以早期诊断非ST段抬高型心肌梗死。
