Investigation of the clinical role of serum copeptin level in unstable angina pectoris (USAP) and its validity in short term prognosis

The aim of this study was to determine the value of the combined use of copeptin levels and HEART scoring system in predicting clinical features in patients who were thought to have Unstable Angina Pectoris (USAP) in the emergency department (ED). Adult patients who admitted to the ED of Bursa Uludag University Medical Faculty Hospital with cardiac chest pain between September 2020 and March 2021 were included as; USAP group (n=65) and healthy control group (n = 45) which consisted of the hospital staff. 81.5% of the cases were male and the mean age was 51.17 ± 14.77 years. The mean HEART scores of the subjects included in the study were 3.51 ± 1.71 (32.3% low risk, 36.9% moderate risk, 30.8% high risk). 83.1% of the cases were discharged, hospitalization was recommended/referred for 16.9%, 3% were operated and 47.7% of the cases were consulted to the cardiology department. Compared to the control group, the frequency of male gender, age, and troponin values recorded at admission were statistically significantly higher in the USAP group, while copeptin levels at admission were significantly lower (p<0.001). Copeptin level at admission was 57.8% sensitive and 95.4% specific at the cut-off point of 3.86 pmol/L in terms of identifying healthy cases, whereas the troponin level was 64.6% sensitive and 80.0% specific at the cut-off point of 1.1 ng/mL for detecting USAP cases (p<0.001). Compared to the low-risk group according to the HEART score, age, admission (0. hour) and 3rd hour troponin level, and the frequency of chronic diseases (Hypertension and Coronary Artery Disease) were statistically significantly higher in the intermediate and high-risk group (p<0.05). As the risk increased according to the HEART score, the frequency of discharge decreased statistically significantly, and the frequency of consultation with the cardiology department, hospitalization, and intervention/treatment within 1 X month increased (p<0.05). There was a weak negative correlation between troponin and copeptin levels recorded at admission (r= -0.288, p = 0.020), and a weak positive correlation between HEART score and troponin level at admission (r= 0.396, p= 0.001). No significant correlation was found between the levels of copeptin and the final result and HEART score. It was determined that the use of copeptin level alone in USAP cases were not sufficient to predict the final result and the HEART score could be more beneficial in clinical practice in this respect.