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Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes

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Abstract

Background

The aim of the current study was to evaluate the diagnostic and intermediate-term prognostic impact of C-terminal portion of provasopressin (copeptin) in combination with troponin I.

Methods

In this prospective single-center study we recruited a total of 230 unselected patients with suspected recent acute coronary syndrome (ACS) presenting consecutively at our chest pain unit. Troponin I and copeptin levels were determined at presentation and after 3–6 h. Follow-up was performed after 180 days.

Results

Acute myocardial infarction (AMI) was the final diagnosis in 107 patients (STEMI: 24, NSTEMI: 83). The median copeptin level was significantly higher in patients having AMI than in those without (20.83 vs. 12.2 pmol/L, p < 0.0001). A troponin I level <0.04 ng/mL in combination with copeptin <14 pmol/L at admission ruled out AMI with an negative predictive value (NPV) of 97.3 %. p = 0.0045 for the added value of copeptin to troponin I. Kaplan–Meier analysis showed that copeptin levels above the diagnostic cut-off were associated with an elevated intermediate-term (180 days) mortality (p = 0.019), while no patient with copeptin values below the cut-off died. Univariate Cox regression analysis identified copeptin as strong predictor of intermediate-term mortality (HR 4.28, 95 % CI 1.58−11.6, p = 0.004). The predictive performance for prediction of 180-day mortality was significantly better if copeptin was included (C-index of 0.80) compared with that of troponin alone (C-index 0.78, p = 0.01 for the added value of copeptin to troponin I).

Conclusions

Additional assessment of copeptin allows a rapid and reliable exclusion of AMI and improves diagnostic accuracy in myocardial ischemia. This study showed for the first time that copeptin provides valuable predictive information for risk stratification and intermediate-term outcome in ACS patients.

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Abbreviations

ACS:

Acute coronary syndrome

AMI:

Acute myocardial infarction

AVP:

Arginine-vasopressin

AUC:

Area under the curve

CAD:

Coronary artery disease

CAG:

Coronary angiography

CI:

Confidence interval

CV:

Coefficient of variation

cTnT:

Cardiac troponin T

ECG:

Electrocardiograph

ED:

Emergency department

GRACE:

Global registration of acute coronary events

HR:

Hazard ratio

HscTnT:

High-sensitivity cardiac troponin T

IQR:

Inter quartile range

NPV:

Negative predictive value

NSTEMI:

Non-ST-segment elevation myocardial infarction

PPV:

Positive predictive value

ROC:

Receiver operating characteristics

STEMI:

ST-segment elevation myocardial infarction

TIMI:

Thrombolysis in myocardial infarction

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Acknowledgments

The authors are indebted to Mrs. Renate Kwiotek from the Institute of Clinical Chemistry and Laboratory Medicine for her excellent technical assistance and, of course, all patients who agreed to participate in the study. B.R.A.H.M.S GmbH, Hennigsdorf, Germany provided us reagents and kits for the copeptin assay. They played no role in the design of study, choice of enrolled patients, review or interpretation of data, or preparation or approval of manuscript. Jörn Ole Vollert and Sabine Hertel are employees of BRAHMS GmbH, part of Thermo Fisher Scientific.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany

    Dariush Afzali, Johannes Waltenberger, Holger Reinecke & Pia Lebiedz

  2. Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Muenster, Muenster, Germany

    Michael Erren

  3. Department of Medicine D, University Hospital of Muenster, Muenster, Germany

    Hermann-Joseph Pavenstädt

  4. Clinical Diagnostics, Thermo Scientific Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany

    Jörn Ole Vollert & Sabine Hertel

Authors
  1. Dariush Afzali
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  2. Michael Erren
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Correspondence to Dariush Afzali.

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Afzali, D., Erren, M., Pavenstädt, HJ. et al. Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes. Clin Res Cardiol 102, 755–763 (2013). https://doi.org/10.1007/s00392-013-0583-0

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  • DOI: https://doi.org/10.1007/s00392-013-0583-0

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