European Heart Journal Advance Access originally published online on April 3, 2009
European Heart Journal 2009 30(10):1187-1194; doi:10.1093/eurheartj/ehp098
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C-terminal provasopressin (copeptin) is a strong prognostic marker in patients with heart failure after an acute myocardial infarction: results from the OPTIMAAL study
1 Department of Cardiology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
2 Applied Cachexia Research, Department of Cardiology, Charité Campus, Virchow-Klinikum, Berlin, Germany
3 Department of Clinical Cardiology, NHLI London, London, UK
4 BRAHMS Aktiengesellschaft, Hennigsdorf, Germany
5 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
6 University of Bergen, Stavanger University Hospital, Norway
Received 12 September 2008; revised 21 January 2009; accepted 26 February 2009; online publish-ahead-of-print 3 April 2009.
* Corresponding author. Tel: +31 50 3612355, Fax: +31 50 3614391, Email: a.a.voors{at}thorax.umcg.nl
Aims: The aim of the present study was to compare the prognostic value of a novel and promising marker, copeptin, with B-type natriuretic peptide (BNP), and N-terminal pro-BNP (NT-proBNP), on death or a composite cardiovascular endpoint in patients who developed heart failure after an acute myocardial infarction (AMI).
Methods and results: From a subset of 224 patients of the OPTIMAAL study, blood samples were drawn at a mean of 3 days after AMI when all patients had signs and/or symptoms of heart failure or a left ventricular ejection fraction <0.35. Endpoints of interest were mortality (primary endpoint of OPTIMAAL) and a composite cardiovascular endpoint, including death, MI, stroke, and/or resuscitated cardiac arrest. Mean age was 67 ± 10 years, and mean follow-up was 33 ± 7 months. Using univariable Cox proportional hazards survival analysis, higher levels of copeptin, BNP, and NT-proBNP were all significantly related to both mortality and the composite cardiovascular endpoint (all P < 0.01). In a multivariable Cox proportional hazards model, including all three biomarkers and other relevant covariates, a doubling of copeptin was related to a 1.83 (1.26–2.64) times increased risk of mortality (P < 0.0001) and a 1.35 (1.05–1.72) times increased risk of the composite cardiovascular endpoint (P = 0.018). Receiver operating characteristic curves indicated that copeptin [area under curve (AUC) 0.81] was a stronger predictor of mortality compared with both BNP (AUC 0.66; P = 0.0063 vs. copeptin) and NT-proBNP (AUC 0.67; P = 0.0016 vs. copeptin). Finally, changes of copeptin levels after 1 month significantly added prognostic information to the baseline value.
Conclusion: Copeptin is a strong and novel marker for mortality and morbidity in patients with heart failure after AMI. In this population, the predictive value of copeptin was even stronger than BNP and NT-proBNP.
Key Words: Heart failure • Myocardial infarction • Mortality • Vasopressin • Natriuretic peptides