Copeptin for the differentiation of type 1 versus type 2 myocardial infarction or myocardial injury

• Published in: International journal of cardiology 2024-05, Vol.403, p.131879-131879, Article 131879
• Main Authors: Kassem, Mona, Ayala, Pedro Lopez, Andric-Cancarevic, Tijana, Tajsic, Milos, Vargas, Kris G., Bendik, Dimitri, Kaufmann, Christoph, Wojta, Johann, Mueller, Christian, Huber, Kurt
• Format: Article
• Language: English
• Subjects: Chest pain; Copeptin; Myocardial infarction; Myocardial injury
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2024.131879

The rapid and reliable differentiation of myocardial infarction (MI) due to atherothrombosis (T1MI) from MI due to supply-demand mismatch (T2MI) or acute myocardial injury is of major clinical relevance due to very different treatments, but still a major unmet clinical need. This study aimed to investigate whether copeptin, a stress hormone produced in the hypothalamus, helps to differentiate between T1MI versus T2MI or injury. In a retrospective analysis, 1271 unselected consecutive patients presenting with symptoms suggestive of MI to the emergency department were evaluated. Patients diagnosed with ST-elevation MI were excluded. All patients with elevated cardiac troponin I (cTnI) concentration possibly indicating MI were classified into T1MI, T2MI, or acute myocardial injury using detailed clinical assessment and coronary imaging. Copeptin plasma concentration was measured in a blinded fashion. A multicenter diagnostic study with central adjudication of the final diagnosis served as external validation cohort (n = 1390). Among 1161 patients, 154 patients had increased cTnI concentration. Of these, 78 patients (51%) were classified as T1MI and 76 (49%) as T2MI or myocardial injury. Patients with T2MI or myocardial injury had significantly higher copeptin plasma concentration between patients versus T1MI (21,4 pmol/l versus 8,1 pmol/l, p = 0,001). A multivariable regression analysis revealed that higher concentrations of copeptin and C-reactive protein, higher heart rate at presentation and lower frequency of smoking remained significantly associated with T2MI and myocardial injury. Findings were largely confirmed in the external validation cohort. In patients without ST-segment elevation, copeptin concentration was higher in T2MI and myocardial Injury versus T1MI and may help in their differential diagnosis. •First, patients with MI had significantly higher median copeptin plasma concentrations compared to non-MI patients.•Patients with a T2MI/myocardial injury had significantly higher median copeptin concentrations than patients having a T1MI.•The diagnostic accuracy for copeptin in differentiating between MI-types is only moderate to low.•Mean age and heart rate were statistically higher in T2MI. History of smoking, dyslipidemia and a positive family history for CVD were more common in T1MI.