Potential Clinical Application of Novel Cardiac Biomarker (Troponin) and Stress Marker (Copeptin) for the Diagnosis of Acute Myocardial Infarction in the Emergency Department

Acute myocardial infarction is the major cause of death and disability worldwide, with an ongoing increase in incidence every year. Therefore, diagnosis of acute myocardial infarction should be made early and accurately to decrease the associated mortality and morbidity. The current gold standard cardiac biomarkers (Troponin and CKMB) for rapid rule in and rule out for acute myocardial infarction has downside since these biomarkers do not rise within first hours from onset of AMI. The delayed increase in detectable circulating levels of these markers contributes to delay in diagnosis and therapy in patients presenting early to the emergency department. The use of Copeptin (AVP), an anti-diuretic hormone of the hypothalamic pituitary axis which rises early after AMI has a good diagnostic accuracy when used together with cardiac troponin. This dual marker strategy of combining troponin and copeptin safely rule out acute myocardial infarction with high sensitivity and negative predictive value of >99%. These novel markers are not only used for establishing the diagnosis of AMI but also helpful for determining prognosis and further stratifying patients at high risks that would determine the therapeutic approach.