Copeptin in Acute Myocardial Infarction: Is There a Role in the Era of High-Sensitivity Troponins?

The battle against coronary artery disease has been in the spotlight for decades. Ongoing research focuses on refined biomarker strategies for the early identification and disposition of patients with symptoms suggestive of acute myocardial infarction (AMI). Copeptin, a surrogate of the hormone arginine vasopressin, has emerged as a novel biomarker that could potentially aid in the diagnos-tic approach of patients with chest pain presenting to the emergency department. Observational studies have demonstrated that copeptin is upregulated in patients with AMI, although the exact pathophysiological mechanisms implicated in its release during myocardial ischemia remain un-clear. Following these observations, copeptin was proposed as an adjunct to troponin in an effort to augment diagnostic accuracy of conventional troponin assays. However, after the introduction of high-sensitivity troponin assays, the diagnostic utility of copeptin has been debated. This narra-tive review aims to elucidate plausible pathophysiological mechanisms involved in copeptin re-lease during myocardial ischemia and to summarize most recent evidence regarding its diagnostic potential in combination with high-sensitivity troponin assays.