الفهرس 
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Abstract
There is a need for early diagnostic and sensitive markers for cardiac ischemia in ED to avoid misleading of diagnosis in patients presenting with AMI. Objective : The aim of this study was to throw a light on the use of serum copeptin, hs-cardiac Tropnin-T) (hs-cTnT) and hs-C Reactive Protein (hs-CRP) as sensitive and early useful markers for rapid reliable exclusion of AMI from other forms of acute chest pain in high risk groups (diabetics, hypertensive and heavy smokers). Patients and methods : This study was conducted on 84 subjects [42 patients with acute myocardial chest pain (group I) and 42 apparently healthy individuals (group II)] selected from Cardiology Department of Specialized Medical Hospital, Mansoura University and Al-Zahraa Hospitals, AL-Azhar University (Emergency and Intensive Care Units), All participants and were subjected to the followings: full history and clinical examination, routine investigations and specific laboratory investigations (copeptin, hs-cTnT and hs-CRP) assayed by ELIZA. Results : A statistical highly significant increased (P<0.001) levels of serum copeptin, hs-cTnT, hs-CRP in group I (especially in all risky subgroups) when compared to controls. A significant positive correlation (P<0.05) between the serum levels of copeptin and RBS, HbA1c%, SBP, DBP, TLC, hs-cTnT and hs-CRP, in group-I Conclusion: from this study we can concluded that : (1)- Serum copeptin is considered more predictive and sensitive marker (97.6%) for early diagnosis of acute chest pain of myocardial origin, because it increases very early after the onset of chest pain. (2)- The combination of two biomarkers copeptin and standard cTnT, are important as they can rapid rule out AMI in ED in high risk groups while hs-cTnT can be used alone for early diagnosis of AMI. (3)- The negative results for both standard cTns and copeptin level at presentation indicates a 99% probability that the patient was not having AMI.