Copeptin, Troponin-I, Pro-BNP and hs-CRP levels in Diagnosing Acute Coronary Syndromes

Background: Chest pain is a frequent symptom patients present with to the emergency room. Copeptin, the Cterminal fragment of arginine-vasopressin, is a marker of stressful situations. Recent studies showed that normal levels of copeptin combined with a normal troponin accurately excluded the diagnosis of acute coronary syndrome (ACS). In this prospective, single center study we evaluated if negative levels of copeptin, pro-BNP and hs-CRP combined with negative troponin (cTn-I) can accurately rule out the diagnosis of ACS and also other life-threatening causes of chest pain. Results: Of 120 enrolled patients (69.2% males, median age 60 yrs), 31.7% were diagnosed with ST elevation myocardial infarction (STEMI), 17.5% with non ST‐elevation myocardial infarction (NSTEMI), 17.5% with unstable angina (USAP), 12.5% stable angina pectoris (SAP) and 20.8% normal coronary arteries (NCA). Copeptin levels were significantly higher in ACS patients with STEMI and NSTEMI than in those with other diagnoses (0.855 ± 0.279 vs. 0.516 ± 0.127, p<0.001). In the correlation analyses, copeptin and cTn-I, and copeptin and pro-BNP were positively correlated (r values 0.397; p<0.001). Diagnostic accuracy of copeptin over 0.583, had 91% sensitivity and 79% specificity the myocardial infarction (95% CI 0.86 to 0.91). Conclusions: The combined use of copeptin, pro-BNP, hs-CRP and cTn-I significantly improved the diagnostic accuracy of troponin alone both in myocardial infarctions and in other life-threatening diseases. Measurement of these markers might be therefore considered not only as a rule-out strategy but also as a warning sign of lifethreatening disease.