title: Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes.
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.
authors.affiliation: Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany, D.Afzali@gmx.de.
authors.forename: Dariush
authors.initials: D
authors.lastname: Afzali
authors.forename: Michael
authors.initials: M
authors.lastname: Erren
authors.forename: Hermann-Joseph
authors.initials: HJ
authors.lastname: Pavenstädt
authors.forename: Jörn Ole
authors.initials: JO
authors.lastname: Vollert
authors.forename: Sabine
authors.initials: S
authors.lastname: Hertel
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.forename: Pia
authors.initials: P
authors.lastname: Lebiedz
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D013997:Time Factors; D019210:Troponin I / Q000378:metabolism*
chemical_list: D006020:Glycopeptides; D019210:Troponin I; C048197:copeptins