Evaluation of Copeptin and High-Sensitivity Troponin I in Early Diagnosis of Acute Coronary Syndrome

Suhaib Saber Asaad; Jassim Muhammed Ibrahima

doi:10.24017/science.2026.1.12

Authors

Suhaib Saber Asaad Physiology, Biochemistry and Pharmacology Department, School of Medicine, University of Kurdistan Hewlêr, Erbil, Iraq
Jassim Muhammed Ibrahima Physiology, Biochemistry and Pharmacology Department, School of Medicine, University of Kurdistan Hewlêr, Erbil, Iraq

Abstract

Acute Coronary Syndrome (ACS) is still the main reason of malady and death world-wide, highlighting needs for quick andaccurate diagnosis. Biomarkers such as high-sensitivity troponin and copeptin have been known to improve early detection. This study aims to evaluate the levels and clinical significance of copeptin and high-sensitivity troponin I in patients presenting with acute coronary syndrome. A prospective observational study enrolled patients presenting with acute chest pain, who were categorized into ACS and non-ACS groups. The relationship between high-sensitivity troponin (HS-troponin) and copeptin was examined. In the total of 100 participants included 62 for ACS group and 38 for non-ACS group. Patients with ACS were significantly older (52.6 vs 44.1 years, p = 0.0010) and more often overweight (51.6% vs. 23.7%, p = 0.0461). Lipid abnormalities were markedly higher in ACS patients, including elevated total cholesterol (48.4% vs 2.6%, p < 0.0001).), low density lipoprotein (37.1% vs 0%, p < 0.0001).), low high density lipoprotein (93.6% vs 60.5%, p < 0.0001).), and high triglycerides (79.0% vs 15.8%, p < 0.0001). Clinically, dyspnea (96.8% vs 73.7%, p = 0.0009), arm pain radiation (67.7% vs 28.9%, p = 0.0002), and nausea/vomiting (59.7% vs 26.3%, p = 0.0012) were significantly more common in ACS. However, copeptin levels and the HS-troponin × copeptin interaction didn’t vary significantly between groups (p = 0.4516). Similarly, no significant variation was observed across lipid categories. While traditional risk factors, symptoms, and lipid abnormalities were strongly associated with ACS, these findings suggest that in high-stress, comorbid clinical settings, copeptin's biomarker specificity is attenuated by systemic physiological demand. In conclusion, evaluation of copeptin and high-sensitivity troponin I shows a critical knowledge in early acute coronary syndrome triage. However, due to the systemic stress attenuates copeptin specificity, localized reference intervals are recommended for accurate clinical assessment.

Keywords:

Acute coronary syndrome, Cardiac biomarkers, Early rule-out strategy, Vasopressin surrogate marker, Dual-biomarker approach, Chest pain

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