title: Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease.
abstract: BACKGROUND
  C-terminal portion of provasopressin (copeptin) has recently been discussed as a novel biomarker for the early rule-out of acute myocardial infarction (AMI). The aim is to investigate the prognostic value of copeptin with regard to mortality and morbidity in patients with symptomatic coronary artery disease (CAD).
  
  
  METHODS
  We consecutively recruited a cath lab cohort of 2,700 patients (74.1% male; AMI, n=1316; stable angina pectoris, n=1384) presenting to the emergency department of a large primary care hospital. All patients received coronary angiography. Copeptin and other laboratory markers were sampled at the time of presentation or in the cath lab. Clinical outcomes were assessed by hospital chart analysis and telephone interviews. 2621 patients (97.1%) have been successfully followed-up at three months. The primary endpoint was a combined endpoint of rehospitalization for cardiovascular events, stroke, and all-cause death.
  
  
  RESULTS
  Using receiver operating characteristic curves, we calculated areas under the curve of 0.703 (95%confidence interval(CI):0.681-0.725) for the composite endpoint after three months (myocardial reinfarction, stroke, all-cause death;n=183), and 0.770 (95%CI:0.736-0.803) for all-cause death (n=76) for copeptin. A cutoff value of 21.6 pmol/L for the composite endpoint yielded a sensitivity of 56.3% and a specificity of 78.6%. The predictive performance of copeptin was independent of other clinical variables or cardiovascular risk factors, and superior to that of troponin I or other cardiac biomarkers (all:P<0.0001).
  
  
  CONCLUSIONS
  Copeptin may help in the prediction of major adverse cardiovascular events in patients with symptomatic CAD. Further studies should substantiate the findings and support the suggested cutoff value of the present study.
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. stephan.von.haehling@web.de
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Jana
authors.initials: J
authors.lastname: Papassotiriou
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stellos
authors.forename: Thomas
authors.initials: T
authors.lastname: Wurster
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.forename: Boris
authors.initials: B
authors.lastname: Bigalke
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications*; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins