Clinical Value Of Copeptin In The Early Diagnosis Of Acute Myocardial Infarction

BackgroundAccording to the World Health Organization,more than 7.2 million people suffer from Acute myocardial infarction(AMI)or other myocardial ischemic diseases each year.Although the number of deaths has decreased significantly in recent years,the mortality and disability rate of AMI remains high.This is because the occurrence of Acute myocardial infarction is often accompanied by myocardial necrosis,cardiac insufficiency and malignant arrhythmia,and 20% of patients will re-emerge with cardiovascular events even during hospitalization.As a result,more and more people are realizing that the accuracy of rapid correlation detection and diagnosis is critical to ensuring effective early treatment of AMI and alleviating patient suffering.In addition to typical clinical symptoms and Electrocardiogram(ECG)abnormalities,the diagnosis of Acute myocardial infarction(AMI)depends primarily on biomarker levels.As the "gold standard" for diagnosis-Cardiac troponin(cTn),it did not increase in the early stage of the disease,and the Electrocardiogram lacked specificity.Therefore,the early diagnosis of Acute myocardial infarction is very challenging,and new markers have received much attention.Arginine vasopressin(AVP),also known as vasopressin,is one of the important hormones secreted by the hypothalamic-pituitary-adrenal axis.However,its half-life is short and measurement is difficult.It is difficult to apply clinically.C-terminal portion of pro-vasopressin,a C-terminal part of arginine vasopressin containing 39 amino acids(molecular weight of about 5 kDa),although the specific physiological functions are largely unclear.However,Copeptin has been widely used as a stress hormone in the fields of Cardiovascular disease,Sepsis,Pneumonia,Lower respiratory tract infection and Stroke.As a glycosylated Copeptin precursor of Arginine vasopressin(AVP),Copeptin is more stable and easier to measure.It is a good substitute for AVP.PurposeThe study compared the levels of Copeptin,Troponin I,Creatine kinase isoenzyme(CK-MB)and Myoglobin(Myo)in the early stages of Acute myocardial infarction.To investigate the diagnostic value of Copeptin in the early stage of Acute myocardial infarction(AMI).MethodAfter enrollment and exclusion,102 patients who underwent chest pain from November 2017 to December 2018 and who were admitted to the Department of Cardiology and Emergency Department of the First Affiliated Hospital of Henan University within 6 hours were enrolled.All blood samples were collected at the same time.After centrifugation,the serum was collected and stored at-80 °C to detect Copeptin,cTnI,CK-MB,Myoglobin and related biochemical indicators.At the same time,the patient’s basic clinical data(including age,gender,blood pressure,past medical history,risk factors related to coronary heart disease,etc.)were collected.All patients underwent percutaneous Coronary angiography(CAG)before discharge,and improved related examinations and tests,followed by continuous monitoring of troponin levels.According to clinical manifestations,coronary angiography results and marker level diagnosis,the patients were divided into Acute myocardial infarction group(AMI group),Unstable angina group(Unstable angina pectoris,UAP)and control group(SCAD group).The basic clinical data of Copeptin,cTnI,CK-MB,Myoglobin and other biochemical indicators were compared among different groups.Patients were then grouped into 0-2h,2-4h,and 4-6h groups based on the time of chest pain episodes to the time of admission to the hospital.The changes of Copeptin,cTnI,CK-MB and Myoglobin levels were compared at different times.The Receiver operating characteristic curve(ROC)was plotted and the area under the ROC curve(AUC)was calculated.Result:1.Among the patients in the AMI group,UAP group and control group,there were 48 patients in the AMI group,including 33 males and 15 females,aged 28-84 years,with an average age of 56.94±16.13 years.There were 34 patients in the UAP group,19 males and 15 females,aged 33-79 years,with an average age of 58.65±11.79 years.There were 20 patients in the control group,9 males and 11 females,aged 29-72 years,with an average age of 52.75±12.14 years old.There were no significant differences in the age,sex ratio,history of hypertension,history of hypertension,systolic blood pressure,diastolic blood pressure,history of diabetes,TC,TG,and creatinine among the three groups(P>0.05).The smoking rate was significantly higher in the AMI group than in the control group(P<0.05).The LDL-C level in the AMI group and the UAP group was higher than control group,and the difference was statistically significant(P<0.05).There was no significant difference in LDL-C between the AMI group and the UAP group(P>0.05).The blood glucose in AMI group was higher than that in UAP group and control group(P<0.05).There was no significant difference in blood glucose between UAP group and control group(P>0.05).The level of NT-proBNP in AMI group was higher than that in control group and UAP group(P<0.05).There was no significant difference between NT-proBNP and control group in UAP group(P>0.05).2.The levels of Copeptin,CK-MB,cTnI and Myoglobin in AMI group were significantly higher than others,and the difference was statistically significant(P<0.05)。The level of cTnI in UAP group and control group was statistical difference(P < 0.05).There was no significant difference in Copeptin,CK-MB and Myoglobin between the UAP group and the control group(P>0.05).3.Within 6 hours of chest pain,the Copeptin of AMI group was significantly higher than that in the UAP group and the control group,and the difference was statistically significant(P<0.05).The UAP group and the control group was no significant difference(P>0.05).There was no significant difference in CK-MB within 2h(P>0.05).During the 2-6h,the level of AMI was higher than that of UAP group and control group,and the difference was statistically significant(P<0.05).There was no significant difference in cTnI levels within 2 h(P>0.05).During the 2-4h period,the AMI group was higher than the control group,and the difference was statistically significant(P<0.05).The AMI group was higher than the UAP group and the control group during the 4-6h period,and the difference was statistically significant(P<0.05).Myoglobin was not significantly different between the three groups within 2 hours(P>0.05).During 2-6h,the Myoglobin level in the AMI group was higher than that in the UAP group and the control group,and there was significant difference(P<0.05).There was no significant difference between the UAP group and the control group(P>0.05).4.The area under the ROC curve of Copeptin was 0.870(95% CI 0.799-0.941),and the sensitivity and specificity were 77.1% and 87.0%.There was a moderate diagnostic effect,which was statistically significant(P < 0.001).The cut-off value of Copeptin was 14.165 pmol/L.The areas under the ROC curve of Myoglobin,CK-MB and cTnI were 0.827(95% CI 0.737-0.918),0.864(95% CI 0.793-0.935),and 0.774(95% CI 0.683-0.864).They were statistically significant(P < 0.001).After combined with the gold standard "cTnI",the AUC of cTnI combined with Copeptin was 0.903(95% CI 0.834-0.973)(P < 0.001).The AUC of cTnI combined with CK-MB was 0.881(95% CI 0.805-0.956)(P < 0.001).The AUC of cTnI combined with Myoglobin was 0.876(95% CI 0.789-0.962)(P < 0.001).The combined diagnostic value was improved and significantly better than the single test(P < 0.001).Comprehensive analysis can be concluded that the diagnostic efficacy of cTnI combined with Copeptin maybe optimal.Conclusion1.While cTnI and Myoglobin did not increase,Copeptin began to rise in the early stage of Acute myocardial infarction(within 2h)and was higher than the cut-off value.2.Compared with alone,Copeptin may have the best diagnostic efficacy in the early stage of Acute myocardial infarction.Combined detection of cTnI may improve the diagnostic value,in which Copeptin and cTnI are the best.They are better than the separate detection.