Abstract 3391: C-terminal proVasopressin (Copeptin) as a Novel and Prognostic Marker In Acute Myocardial Infarction- The Leicester Acute Myocardial infarction Peptide (LAMP) Study
Background: Investigation of the role of the vasopressin (VP) system post acute myocardial infarction (AMI) was hampered by instability of VP. Copeptin, the C-terminal part of the VP prohormone, is a stable peptide secreted in equimolar amounts to VP. We investigated the prognostic value of Copeptin and compared it to N terminal B type natriuretic peptide (NT-BNP), a marker of death and heart failure post AMI.
Methods: We studied 980 consecutive post AMI patients (718 men, mean age 65.0 ± 12.2 years). Plasma measurements were made 3–5 days after chest pain onset. NT-BNP was determined using an in-house non-competitive immunoassay and Copeptin was detected using a novel commercial assay (BRAHMS AG). Patients were followed-up for the combined endpoint of death or heart failure.
Results: Over the median follow up period of 342 days (range 0–764) there were 101 deaths and 49 readmissions with heart failure. Copeptin was raised in patients with death or heart failure compared to survivors (median [range] pmol/L, 21.3[0.6–441.0] vs. 6.5[0.3–267.0], p<0.0001). Using a multivariate binary logistic model log Copeptin (OR 2.02), log NT-BNP (OR 3.26), log creatinine (OR 10.43), age (OR 1.04), male gender (OR 0.59) and past history of MI (OR 2.72), were significant independent predictors of death or heart failure. The receiver-operating curve for Copeptin yielded an area under the curve (AUC) of 0.71 (95% CI: 0.67–0.76, p<0.001); for NT-BNP the AUC was 0.79 (95% CI: 0.75–0.83, p<0.001); the logistic model combining the 2 markers yielded an AUC of 0.84 (95% CI: 0.81–0.88, p<0.001). The Cox proportional hazards model for predicting death or heart failure consisted of the same variables (including log Copeptin (HR 2.1), log NT-BNP (HR 2.64)). Kaplan-Meier analysis revealed significantly better clinical outcome in patients with Copeptin below the median in patients stratified by NT-BNP (above median, P<0.0001). Similar findings were obtained with death and heart failure as individual endpoints.
Conclusion: The vasopressin system is activated post AMI. Copeptin is a powerful new predictor of death or heart failure, especially in patients with NT-BNP above the median. A multimarker approach with copeptin and NT-BNP is more informative than either marker alone.