C-Terminal Provasopressin (Copeptin) as Prognostic Marker after Acute Non ST Elevation Myocardial Infarction - Leicester Acute Myocardial Infarction Peptide II (LAMP II) study.
Résumé
Background Copeptin, the 39 amino acid C-terminal portion of provasopressin, has been shown to be an independent predictor for adverse events following ST elevation myocardial infarction. We hypothesized that plasma copeptin was an independent predictor for adverse outcomes following acute non ST elevation myocardial infarction (NSTEMI) and evaluated whether copeptin added prognostic information to the GRACE score compared to NTproBNP. Methods Plasma copeptin and NTproBNP were measured in 754 consecutive patients admitted to hospital with chest pain and diagnosed as having NSTEMI in this prospective observational study. The endpoint was all cause mortality at 6 months. Results: Upper median levels of copeptin were strongly associated with all cause mortality at 6 months. Copeptin was a significant predictor of time to mortality (HR = 5.98 [3.75 to 9.53], p < 0.0005) in univariate analysis and remained a significant predictor in multivariate analysis (HR = 3.03 [1.32 to 6.98], p = 0.009). There were no significant differences between the area under ROC curves of copeptin, NTproBNP and the GRACE score. Copeptin improved accuracy of risk classification when used in combination with the GRACE score as determined by net reclassification improvement whereas NTproBNP did not. The relative utility of the GRACE score was increased more by copeptin than by NTproBNP over a wide range of risks. Conclusions: Plasma copeptin is elevated after NSTEMI and higher levels are associated with worse outcomes. Copeptin used in conjunction with the GRACE score improves risk stratification enabling more accurate identification of high risk individuals.
Domaines
Médecine humaine et pathologie
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