Copeptin for acute coronary syndrome: diamond or decoy?

摘要

The article "Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin" by G. Lippi et al. (1) discusses copeptin as a promising biomarker and proposes an algorithm to rule-out myocardial infarction. Diagnosing and ruling out myocardial infarction is an important challenge for the clinician and remains so, even despite the recent advent of high sensitive troponin. Any tool that alleviates this challenge is highly welcome and is likely to improve patient care. Copeptin is the stable signal peptide of the vasopressin precursor and elevated plasma concentrations have been shown in myocardial infarction, sepsis, shock, pneumonia and other diseases. It is therefore (also) considered as unspe-cific marker of stress. In the current article, it is proposed that this marker, in combination with a negative first troponin, helps to rule out myocardial infarction more quickly and specifically than with current management of repeated troponin testing. Although interesting, this unconventional approach (unspecific marker should improve diagnosis of a specific disease, staged application after first negative troponin for rule-out only) leaves open several questions which should be resolved before the true clinical potential of copeptin for assessment for myocardial infarction becomes clearer.