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

Autor: Kassem M; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria. Electronic address: mona.ah.kassem@gmail.com., Ayala PL; Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland., Andric-Cancarevic T; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria., Tajsic M; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria., Vargas KG; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Bendik D; Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland., Kaufmann C; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria., Wojta J; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria., Mueller C; Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland., Huber K; 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 May 15; Vol. 403, pp. 131879. Date of Electronic Publication: 2024 Feb 16.
DOI: 10.1016/j.ijcard.2024.131879
Abstrakt: Background: 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.
Methods: 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).
Results: 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.
Conclusion: In patients without ST-segment elevation, copeptin concentration was higher in T2MI and myocardial Injury versus T1MI and may help in their differential diagnosis.
Competing Interests: Declaration of competing interest Dr. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the University of Basel, the University Hospital Basel, Abbott, Astra Zeneca, Beckman Coulter, Brahms, Idorsia, LSI-Medience, Novartis, Ortho Clinical Diagnostics, Quidel, Roche, Siemens, Singulex, Sphingotec, as well as speaker honoraria/consulting honoraria from Amgen, Astra Zeneca, Bayer, Beckman Coulter, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler, Roche, Sanofi, Siemens, and Singulex. Dr. Huber has received speaker honoraria/consulting honoraria from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Chiesi, Daiichi Sankyo, Ferrer, Novartis, NovoNordisk, and Sanofi Aventis. All other authors have no COIs. This study received no grant support. No conflicts of interests to declare.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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