NUOVI MARKERS DI DANNO MIOCARDICO: DOLORE TORACICO E COPEPTINA

ABSTRACT Chest pain is one of the most common cause for Emergency Department (ED) visits. Nowadays the diagnostic gold standard for acute myocardial infarction (AMI) is Troponin T but its delayed release reduces the diagnostic sensibility in the early ischemic time. Copeptin, a biomarker associated with endovascular stress regulation, has been studied in various cardiovascular events. The aim of this study is to analyse the diagnostic/prognostic value of copeptin in myocardial infarction patients admitted to ED for chest pain to obtain a careful rule out of AMI. 90 consecutive patients admitted for chest pain were studied. Inclusions criteria were Chest Pain Score > 4 and negative electrocardiography for acute coronary syndrome (ACS) according to the European Society of Cardiology Guidelines 2009. Copeptin was evaluated at the ED presentation. 50 patients were discharged after AMI exclusion with negative copeptin and troponin. 40 patients were admitted, 18 of them had myocardial infarction, 12 had positive copeptin with negative troponin and myoglobin values. The overall copeptin sensibility in the infarcted patients was 69,4%, increasing to 77,7% adding troponin T, with a negative predictive value of 78%. Upon multiple regression frame copeptin appears to be an independent predictor factor of number of vessels involved in ACS (p<0,006). Copeptin blood level risen early in infarcted patients has a good sensibility; the combination with troponin T improved the diagnostic performance of these two biomarkers in AMI patients. Copeptin could be used also as a prognostic factor of myocardial damage because of its correlation with coronary involvement.