Copeptin: A Neuroendocrine Biomarker in Acute Myocardial Infarction

Copeptin is a novel neuroendocrine peptide recently introduced to the field of acute medicine biomarkers. It is 39 amino acids glycopeptide cosynthesized with arginine vasopressin (AVP) and released together in stoichiometric pattern from the hypothalamus upon stimulation of AVP release. Due to difficulties of AVP assay, copeptin largely replaced it in clinical assay as surrogate biomarker because copeptin has easier and more valid measurement methods. In acute stress condition, copeptin rises and reflects stress level exactly like AVP which was largely known as mediator of non-specific stress conditions beside its prominent role in water homeostasis. Acute myocardial infarction (AMI) is an acute stress state in which plasma copeptin rises. Early identification of AMI is a problem due to the delayed appearance of the cardiospecific troponins which start to rise within 6-9 hours from the onset of chest pain. In the recent years many studies concluded that, when copeptin is combined with cardiac troponins in diagnosis of patients presenting with acute chest pain in early hours, it accelerates early rule in of AMI and rule out of non-MI patients. This review article discusses the biochemical and physiological basics of copeptin beside its clinical diagnostic value in AMI according to results and conclusions of some studies carried out on copeptin in AMI diagnostic field.