Abstract 2656: Copeptin Predicts Cardiovascular Death in STEMI Independent of Clinical Factors and NT-proBNP
Background: Elevated levels of copeptin, the c-terminal portion of provasopressin, add significantly to natriuretic peptides for mortality prediction in heart failure. We hypothesized that elevated levels would predict mortality in ST-elevation myocardial infarction (STEMI).
Methods: Circulating copeptin levels were measured at baseline in a case-cohort of 535 STEMI patients undergoing fibrinolysis in CLARITY-TIMI 28. Patients were stratified into quartiles by baseline copeptin. Multivariable logistic regression was used to examine the association between copeptin and 30-d cardiovascular (CV) mortality independent of clinical factors and NT-proBNP.
Results: The median level of copeptin was 615 pg/ml (IQR 333–728 pg/ml). Baseline levels of copeptin tended to be higher in patients who were older, had a prior MI, were treated sooner after sx onset, and were in Killip class II-IV. For each 1-SD increase in log-transformed copeptin, the OR for CV death was 1.45 (p=0.01). After adjusting for differences in baseline characteristics patients in the highest copeptin quartile were at a significantly higher risk of CV death compared with patients in quartiles 1–3 (OR 1.99 [1.05–3.78]). Copeptin was not significantly correlated with NT-proBNP (r=0.09). In a multivariable model, copeptin and NT-proBNP were each significant independent predictors of CV death (Figure⇓); the c-statistic went from 0.75 to 0.81 with their addition to a model containing clinical risk factors.
Conclusion: In a multimarker model, circulating levels of copeptin and NT-proBNP at presentation were powerful and complementary predictors of CV death beyond traditional risk factors in patients with STEMI.