Role of Copeptin and hs-cTnT to Discriminate AHF from Uncomplicated NSTE-ACS with Baseline Elevated hs-cTnT-A
Stephan von Haehling1,2, Matthias Müller-Hennessen3, Tania Garfias-Veitl1,2
1Department of Cardiology and Pneumology, University of Göttingen Medical Center, 37075 Göttingen, Germany.
Insights
Copeptin effectively differentiates acute heart failure (HF) from non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with unclear symptoms. Elevated copeptin levels also indicate a higher risk of 1-year mortality in these patients.
Area of Science:
- Cardiology
- Biomarkers
- Emergency Medicine
Background:
- Distinguishing non-ST-elevation (NSTE) acute coronary syndrome (ACS) from acute heart failure (HF) is clinically challenging due to overlapping symptoms.
- Equivocal presentations in suspected ACS cases complicate accurate diagnosis and risk stratification.
Purpose of the Study:
- To evaluate the diagnostic and prognostic utility of copeptin in differentiating acute HF from uncomplicated NSTE-ACS.
- To compare copeptin's performance against high-sensitivity cardiac troponin T (hs-cTnT) for diagnosis and mortality prediction.
Main Methods:
- Analysis of 1088 patients from an observational registry, with validation in an external NSTE-ACS cohort.
- Serial measurements of copeptin and hs-cTnT were used to discriminate acute HF from NSTE-ACS (NSTEMI and unstable angina).
- All-cause mortality at 365 days was assessed as a prognostic endpoint.
Main Results:
- Copeptin demonstrated superior diagnostic accuracy (AUC 0.725) for acute HF versus NSTE-ACS compared to hs-cTnT (AUC ~0.45).
- High copeptin concentrations were significantly associated with acute HF in patients with equivocal presentations.
- Elevated copeptin and hs-cTnT levels independently predicted higher 1-year all-cause mortality.
Conclusions:
- Copeptin is a valuable biomarker for identifying acute HF in patients with suspected NSTE-ACS and ambiguous clinical findings.
- High copeptin levels in this context are linked to increased 365-day all-cause mortality.
- The findings support copeptin's role in improving diagnostic accuracy and risk assessment in challenging cardiovascular presentations.
Background:
In light of overlapping symptoms, discrimination between non-ST-elevation (NSTE) acute coronary syndrome (ACS) and acute heart failure (HF) is challenging, particularly in patients with equivocal clinical presentation for suspected ACS. We sought to evaluate the diagnostic and prognostic properties of copeptin in this scenario.
Methods:
Data from 1088 patients from a single-center observational registry were used to test the ability of serial high sensitivity cardiac troponin T (hs-cTnT)-compared to copeptin, or a combination of copeptin with hs-cTnT-to discriminate acute HF from uncomplicated non-ST-elevation myocardial infarction (NSTEMI) and to evaluate all-cause mortality after 365 days. Patients with STEMI, those with unstable angina and either normal or undetectable hs-cTnT concentrations were excluded. The findings were validated in an independent external NSTE-ACS cohort.
Results:
A total of 219 patients were included in the analysis. The final diagnosis was acute HF in 56 and NSTE-ACS in 163, with NSTEMI in 78 and unstable angina having stable elevation of hs-cTnT >ULN in 85. The rate of all-cause death at 1 year was 9.6% and occurred significantly more often in acute HF than in NSTE-ACS (15 vs. 6%, p < 0.001). In the test cohort, the area under the receiver operator curve (AUC) for the discrimination of acute HF vs. NSTE-ACS without HF was 0.725 (95% confidence interval [CI] 0.625-0.798) for copeptin and significantly higher than for hs-cTnT at 0 h (AUC = 0.460, 0.370-0.550) or at 3 h (AUC = 0.441, 0.343-0.538). Copeptin and hs-cTnT used either as continuous values or at cutoffs optimized to yield 90% specificity for acute HF were associated with significantly higher age- and sex-adjusted risk for all-cause mortality at 365 days. The findings from the test cohort were consistently replicated in the independent external NSTE-ACS validation cohort.
Conclusions:
High concentrations of copeptin in patients with suspected NSTE-ACS and equivocal clinical presentation suggest the presence of acute HF compared to uncomplicated NSTE-ACS and are associated with higher rates of all-cause death at 365 days.
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