C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction Leicester acute myocardial infarction peptide (LAMP) study

Background - The role of the vasopressin system after acute myocardial infarction is unclear. Copeptin, the C-terminal part of the vasopressin prohormone, is secreted stoichiometrically with vasopressin. We compared the prognostic value of copeptin and an established marker, N-terminal pro-B-type natriuretic peptide ( NTproBNP), after acute myocardial infarction. Methods and Results - In this prospective single-hospital study, we recruited 980 consecutive post-acute myocardial infarction patients ( 718 men, median [ range] age 66 [ 24 to 95] years), with follow-up over 342 ( range 0 to 764) days. Plasma copeptin was highest on admission ( n=132, P<0.001, day 1 versus days 2 to 5) and reached a plateau at days 3 to 5. In the 980 patients, copeptin ( measured at days 3 to 5) was elevated in patients who died ( n=101) or were readmitted with heart failure ( n=49) compared with survivors ( median [ range] 18.5 [ 0.6 to 441.0] versus 6.5 [ 0.3 to 267.0] pmol/L, P<0.0005). With logistic regression analysis, copeptin ( odds ratio, 4.14, P<0.0005) and NTproBNP ( odds ratio, 2.26, P<0.003) were significant independent predictors of death or heart failure at 60 days. The area under the receiver operating characteristic curves for copeptin ( 0.75) and NTproBNP ( 0.76) were similar. The logistic model with both markers yielded a larger area under the curve ( 0.84) than for NTproBNP ( P<0.013) or copeptin ( P<0.003) alone, respectively. Cox modeling predicted death or heart failure with both biomarkers ( log copeptin [ hazard ratio, 2.33], log NTproBNP [ hazard ratio, 2.70]). In patients stratified by NTproBNP ( above the median of approximate to 900 pmol/L), copeptin above the median ( approximate to 7 pmol/L) was associated with poorer outcome ( P<0.0005). Findings were similar for death and heart failure as individual end points. Conclusions - The vasopressin system is activated after acute myocardial infarction. Copeptin may predict adverse outcome, especially in those with an elevated NTproBNP ( more than approximate to 900 pmol/L).