Abstract 15360: Circulation Levels of Vasopressin for Patients in Hyper Acute Phase of Acute Coronary Syndromes
Purpose: Although there is evidence for short-term clinical effects of vasopressin receptor antagonists in patients with Acute Heart failure (JAMA. 2007; 297). Few study are available for risk stratification in the circulation level of Vasopressin with Acute Coronary Syndromes (ACS) patients.
OBJECTIVE: To evaluate the short-term effects of circulation level Vasopressin in patients with ACS.
Methods: We conducted a prospective study of 264 patients with ACS whose Vasopressin, B-type natriuretic peptide, Plasma Renin and Aldosterone were measured on arrival at the emergency room. The primary end point was death from any cause in hospital with follow-up 90 (mean 25 ± 15) days. .
Results: Vasopressin level ranged from 0.6 to 709 pg/ml, with the mean (±SD) of 39.6 ± 70.6 pg/ml, and the median of 16.7pg/ml. The overall mortality rate was 6% and Vasopressin level in patients with death was significantly higher than in those with survival (mean: 138.9 pg/ml vs. 35.2 pg/ml p <0.0001). In the multiple logistic regression analysis for the primary outcome, the adjusted odds ratio in Vasopressin level was 1.014 (95%CI, 1.005 to 1.023, P=0.023). On the other hand, B-type natriuretic peptide, Plasma Renin Activity and Aldosterone were not independent predictors. A receiver-operating-characteristics curve for various cut off levels of Vasopressin to differentiate survival from death was 0.80 (95%CI, 0.65-0.94), and the Vasopressin cut off value of 42.9 pg/ml had the highest combined sensitivity and specificity. Kaplan-Meier analysis was shown that Low Vasopressin (< 42.9 pg/ml) group had a significantly lower incidence of death than High Vasopressin (> 42.9 pg/ml) group (p <0.0001). In addition, Cox proportional hazards analysis indicated that High Vasopressin group was the independent predictor of death with an adjusted odds ratio of 13.0 (95%CI; 2.5-67.1 p=0.002).
Conclusions: The measurement of Vasopressin on arrival at the emergency room was found to provide valuable information regarding the prognosis in ACS patients.
- © 2013 by American Heart Association, Inc.