The following is a summary of “Copeptin for the differentiation of type 1 versus type 2 myocardial infarction or myocardial injury,” published in the May 2024 issue of Cardiology by Kassem et al.
Quick and accurate differentiation of Myocardial Infarction (MI) caused by atherothrombosis (T1MI) from MI due to supply-demand mismatch (T2MI) or acute heart injury is vital for treatment. But, it is still a major unmet clinical need.
Researchers conducted a retrospective study to see if copeptin, a stress hormone in the brain’s hypothalamus, can help distinguish between T1MI and T2MI or injury.
They studied 1,271 patients who came to the ER with possible MI symptoms. However, patients with ST-elevation MI were excluded from the study. Patients with higher cardiac troponin (cTnl) concentrations were sorted into T1MI, T2MI, or heart injury categories using clinical assessment or coronary imaging. Copeptin plasma levels were measured blinded, and all the findings were validated in a separate study of 1,390 patients.
The results showed that out of 1,161 patients, 154 had high cTnl levels. Among them, 78 (51%) were labeled T1MI and 76 (49%) as T2MI or heat injury. Patients with T2MI or heart injury had higher copeptin plasma levels (21.4 pmol/l vs. 8.1 pmol/l, P=0.001). Multivariate analysis showed copeptin, C-reactive protein (CRP), higher heart rate, and smoking were linked to T2MI or injury. These findings were confirmed in the external validation cohort.
Investigators concluded that copeptin levels were higher in T2MI and heart injury than in T1MI in patients without ST-segment elevation. This suggests that copeptin could help distinguish between these conditions.
Source: sciencedirect.com/science/article/abs/pii/S0167527324003255