Abstract 13969: Early Identification of Posterinterventional Type 4a Myocardial Infarction by Copeptin
Introduction PCI-related myocardial infarction (Type 4a MI) occurs frequently and has a negative impact on outcome. Copeptin is a marker of cardiovascular hemodynamic stress. Hypothesis Copeptin values directly after PCI are predictive for the occurrence of Type 4a MI.
Methods We enrolled 135 troponin T (TnT) negative patients scheduled for elective coronary angiography (CA) and possible PCI. For evaluation of MI Type 4a (MI4a) all patients with performed PCI (n=106) were analyzed. Blood samples were drawn at 5 time points: at admission, just before CA, directly after CA/PCI, 6-10 hours and 12-20 hours after CA/PCI. Variables are shown as median and inter quartile ranges.
Results Of all patients with PCI, 22.6% developed a MI4a. Copeptin values at admission and directly before PCI did not differ significantly between patients with and without MI4a (p=0,197 and p=0,262). Copeptin values directly after PCI were significantly higher in patients who developed Type 4aMI (28.9 (11.7-62.5)pmol/L) compared to patients who did not (11.1 (6.5-22.2)pmol/L; figure 1). In ROC-analysis, Copeptin was able to predict MI4a with an AUC of 0.726 (95%-CI: 0.605-0.848, p=0.001). In a logistic regression, an odds ratio of 1.023 (95%-CI: 1.007-1.039, p=0.004) could be shown per one unit increase of the copeptin value. At a cut point of 16 pmol/L, Copeptin was able to predict MI4a with an RR of 3.28 (95%-CI: 1.49-7.20). The odds ratio in logistic regression analysis at this cut-point was 4.76 (95%-CI: 1.75-12.94, p=0.002).
Conclusions: Determination of Copeptin immediately before removal of the sheath after coronary intervention predicts subsequent troponin increase (type 4a MI). Hemodynamic changes during PCI, which can be clinically silent, may reflect the pathophysiology of type 4a MI and identify those patients concerned already directly after the intervention.
- © 2012 by American Heart Association, Inc.