الفهرس 
Acute Coronary SyndromeOnly 14 pages are availabe for public view
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Abstract
Cardiovascular disease is the leading cause of death in developed countries and it is predicted to be the number one killer in developing countries in the year of 2020. Coronary heart disease is the most common culprit of cardiac related death, therefor AMI with its diverse clinical manifestation should be promptly diagnosed or ruled out.
Ruling out AMI is expensive and time consuming. Sometimes, doctors can’t fully rely on clinical findings and ECG examination, since one quarter to one third of patients with AMI present without significant ECG changes. Current guidelines recommend the measurement of the gold standard cardiac troponin for differentiation between unstable angina and myocardial infarction (NSTEMI, STEMI) and 0 hour 3 hour algorithm for early rule out with the high sensitive assays.
However, the current cardiac marker assay i.e. as troponin has its own downside. The delayed rise of troponin (troponin blind period) after AMI warrant doctors to delay their diagnosis and monitor their patients in the emergency room for a longer period of time. This approach not also cause overcrowding in the emergency department but also a great waste of time and money. Therefore, the rapid and safe way to rule out AMI is highly required. In the absence of typical findings of AMI and without any increase of classic cardiac biomarkers such as troponin and CK-MB, it is helpful to have other biomarkers to assist doctor in making clinical judgment and to determine the patient’s prognosis.
COPEPTIN: The level of arginine-vasopressin (AVP) have been shown to be elevated in heart failure and other endogenous stress condition such as critically ill patients. However, AVP is known to be unstable and rapidly cleared from circulation. Copeptin is a C-terminal part of the vasopressin prohormone and secreted in equimolar amounts to vasopressin. In contrast to AVP, copeptin is stable for days and can be quickly measured.
The current study was carried out in the Emergency Department of National Heart Institute during the period from May 2018 to January 2019 on 86 patients presented with symptoms suggestive for Acute Coronary Syndrome.
Patients were classified according to the basis of results of troponin into two groups, troponin positive and troponin negative group. Troponin positive group was 45 patients while the negative group was 41 patients. Venous blood samples were drawn at ER department at the time of admission for all patients who presented within four hours of onset of symptoms and serum copeptin, troponin T and CK MB level were measured, while a 2nd set of troponin and CK MB measured after 6 hours .
All patients were subjected to:
1. History taking
2. ECG
3. Echocardiography
4. Serum Troponin I and Copeptin
The main findings were:
1. The concentration of copeptin was higher in the troponin positive group than the negative one.
2. Copeptin found to be elevated in the very early hours of onset of symptoms while the traditional biomarkers including the gold standard troponin were not detectable.
3. There was a strong correlation between eleveated peak of Copeptin and the peaked CK MB levels, but there was a lack of correlation between abnormally elevated Copeptin and newly impaired EF % of new SWMA appeared in Echo.
4. Our study demonstrated that dual marker strategy that combined normal copeptin and normal conventional troponin T at admission improved the sensitivity and accuracy of ruling out ACS compared to use of cTnT alone.
This strategy will lead to a safe exclusion of NSTE-ACS consequently which required prolonged monitoring over 12 hs with serial blood sampling and this contribute to overcrowding in the emergency department (ED) and associated costs.