Evaluation of Serum Level of Copeptin as an Endogenous Stress Biomarker in the Early Diagnosis of Subtypes of Acute Coronary Syndrome in Iraqi Patients

Background: Acute coronary syndrome (ACS) is still one of the main causes of morbidity and mortality worldwide, and an early diagnosis of acute myocardial infarction (MI) aims to decrease mortality in MI patients. The ACS is manifested as one of three subtypes. These subtypes include MI with the electrocardiogram (ECG) is showing ST-segment elevation (STEMI), the other is MI with the ECG is showing no ST-segment elevation (NSTEMI), and the third type is unstable angina (UA). Objectives: The objectives of this study were to evaluate the role of serum copeptin (CPP) level in early diagnosis of subtypes of ACS. Materials and Methods: One hundred and twenty patients (72 males and 48 females) aged ≥30 years were consecutively selected from those who were admitted and diagnosed as ACS. The ACS patients comprised three subgroups: STEMI, NSTEMI, and UA, while apparently, healthy subjects were recruited as controls for this study. For each study subject, serum CPP was measured. Results: The CPP mean level showed an overall significant difference among study groups. On paired comparison, the CPP mean level was significantly higher in STEMI and NSTEMI subgroups ( P < 0.001) as well as in UA subgroup of ACS patients than in controls ( P < 0.05). On receiver operator characteristic analysis, the CPP levels showed good sensitivity and specificity in differentiation of each ACS subtype patients from controls as well as in differentiation of patients among subtypes of ACS. Conclusion: Serum CPP level is significantly higher in all subtypes of ACS than in controls in the first hours after the onset of acute chest pain in ACS patients in addition to having better sensitivity and specificity in the differentiation of patients among the subtypes of ACS.