Diagnostic Value of Delta Copeptin Levels in Patients with Acute Coronary Syndrome Presenting to the Emergency Department

INTRODUCTION: A significant proportion of patients presenting to the emergency department present with symptoms of acute coronary syndrome (ACS). These symptoms range from simple medical conditions to life-threatening emergencies, making it difficult to diagnose ACS. In this context, studies on various biomarkers for a more effective diagnosis are ongoing. Patients presenting with ACS symptoms come from all age groups and the wide range of symptoms makes it difficult to recognize and manage patients. In this study, we aimed to compare copeptin with high sensitive troponin (hs-tn) level, which is currently used as a diagnostic tool.
METHODS: In this prospective study, 130 patients over the age of 18 who presented to the Emergency Medicine Clinic of Ankara Etlik City Hospital with chest pain between December 10, 2023 and December 20, 2023 and met the inclusion criteria were included. Patients were evaluated in the light of current guidelines (AHA 2021 Chest Pain Guideline, ESC 2020 Non-ST Eleve Myocardial Infarction (NSTEMI) Guideline, ESC 2023 Acute Coronary Syndromes Guideline) and divided into 2 groups as ACS (n=65) and non-ACS (n=65). Delta copeptin and hs-tn levels, HEART scores and vital parameters were evaluated. Statistical analyses were performed using SPSS 23.0 and p<0.05 was considered significant.
RESULTS: There was no significant difference in age and gender between ACS and non- ACS groups (p>0.05). HEART score was significantly higher in the ACS group (p<0.001). Normal sinus rhythm was observed more frequently in the non-ACS group (p=0.024). All ACS patients were hospitalized in the coronary intensive care unit (CICU), whereas the non-ACS group was usually discharged (p<0.001). Troponin levels were significantly higher in the ACS group (p<0.001), while copeptin levels were higher in the non-ACS group (p<0.05). There was no difference between the groups in terms of delta copeptin (p=0.119).
DISCUSSION AND CONCLUSION: Our study confirmed the gold standard role of hs-tn in the diagnosis of ACS and showed that the contribution of copeptin in this field is limited. Studies with larger samples are needed to confirm the results. hs-tn should be used as the primary biomarker in the diagnosis of ACS, whereas copeptin should be considered only as a supportive parameter.