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Abstract
Diagnosis of acute coronary syndrome (ACS) based on copeptin level may enable one to confirm or rule-out acute myocardial infarction (AMI) with higher sensitivity and specificity, which may in turn further reduce mortality rate and decrease the economic costs of ACS treatment. We conducted a systematic review and meta-analysis to investigate the relationship between copeptin levels and type of ACS. We searched Scopus, PubMed, Web of Science, Embase, and Cochrane to locate all articles published up to 10 October 2021. We evaluated a meta-analysis with random-effects models to evaluate differences in copeptin levels. A total of 14,139 patients (4565 with ACS) were included from twenty-seven studies. Copeptin levels in AMI and non-AMI groups varied and amounted to 68.7 ± 74.7 versus 14.8 ± 19.9 pmol/L (SMD = 2.63; 95% CI: 2.02 to 3.24; p < 0.001). Copeptin levels in the AMI group was higher than in the unstable angina (UAP) group, at 51.9 ± 52.5 versus 12.8 ± 19.7 pmol/L (SMD = 1.53; 95% CI: 0.86 to 2.20; p < 0.001). Copeptin levels in ST-elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (NSTEMI) patient groups were 54.8 ± 53.0 versus 28.7 ± 46.8 pmol/L, respectively (SMD = 1.69; 95% CI: = 0.70 to 4.09; p = 0.17). In summary, elevated copeptin levels were observed in patients with ACS compared with patients without ACS. Given its clinical value, copeptin levels may be included in the assessment of patients with ACS as well as for the initial differentiation of ACS.
Highlights
Acute coronary syndromes (ACS) represent the leading cause of morbidity and mortality worldwide [1] and the relative incidences of ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are decreasing and increasing, respectively [2,3], they are still responsible for almost 1.8 million annual deaths [4]
The total number of participants was 14,139. All of those studies focused on the copeptin levels in acute coronary syndrome
The pooled analysis of twenty-six studies showed that copeptin levels in acute myocardial infarction (AMI) and nonAMI groups varied and amounted to 68.7 ± 74.7 versus 14.8 ± 19.9 pmol/L (SMD = 2.63; 95% CI: 2.02 to 3.24; I2 = 99%; p < 0.001) [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,37,38,39,40,41,42,43,44,45,46]
Summary
Acute coronary syndromes (ACS) represent the leading cause of morbidity and mortality worldwide [1] and the relative incidences of ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are decreasing and increasing, respectively [2,3], they are still responsible for almost 1.8 million annual deaths [4]. Parameters, and troponin are crucial in the identification of patients suffering from acute myocardial infarction (AMI) [3,4]. Distinguishing those requiring immediate intervention and hospitalization is a vital issue both for patients and clinicians [5]. Ruling out AMI with ECG and troponins is time-consuming owing to the need for serial blood sampling to determine the changes in troponin concentrations, especially in patients with non-ST-elevation ACS. Copeptin does not require serial sampling, in contrast to troponin [14] and may represent an accurate anchor point to diagnose AMI in patients admitted to ED. The aim of our meta-analysis was to evaluate the diagnostic value of copeptin in ACS
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