Abstract 16571: Temporal Release Pattern of Copeptin and Troponin in Patients With Suspected ACS and Spontaneous Acute Myocardial Infarction

Abstract

Introduction: Copeptin, a surrogate marker for vasopressin has been shown to have potential for the early rule-out of acute myocardial infarction in combination with cardiac troponin. The temporal release pattern of copeptin in spontaneous AMI has not been investigated until now at more than three time-points. Objective: To investigate the temporal release pattern of copeptin and cardiac troponin in spontaneous acute myocardial infarction at six time-points from ambulance until 12-36 hours. Methods: Patients with suspected ACS and acute symptom onset were enrolled in this study. Blood samples were collected on the ambulance, at admission and after 2, 4, 6 and 12-36 hours. Gold-Standard diagnoses were adjudicated according to the third definition of myocardial infarction by a cardiologist. Copeptin (BRAHMS Kryptor Copeptin us) and troponin T (Roche Diagnostics, Elecsys) were measured in heparin plasma. Results: Overall 93 patients were enrolled. The most frequent diagnosis was STEMI (n=37, 39.8%), 20 patients were diagnosed with NSTEMI (21.5%), 20 patients had UAP (21.5%) and 16 patients were diagnosed with other, non-ACS diagnoses (17.2%). The release kinetic of copeptin differed between different diagnoses: patients with AMI had significantly higher values at admission as compared to patients with UAP and other diagnoses (figure 1 A). Troponin values on the ambulance were low in all patients but increased over time in patients with STEMI and NSTEMI (figure 1B). Conclusions: In early presenters with ACS copeptin and troponin show typical temporal release pattern; the very early rise and decrease within 12-36h of copeptin in spontaneous AMI has been shown for the first time. The pathophysiological stimulus for the copeptin-release in spontaneous AMI should be further investigated.