Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
Int J Cardiol. 2012 Dec 15;162(1):27-32. doi: 10.1016/j.ijcard.2011.12.105. Epub 2012 Jan 28.
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).
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.
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).
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.
加压素原 C 端肽（copeptin）最近被讨论为急性心肌梗死（AMI）早期排除的新型生物标志物。本研究旨在探讨 copeptin 对有症状的冠状动脉疾病（CAD）患者死亡率和发病率的预后价值。
我们连续招募了一个 2700 例患者的导管实验室队列（74.1%为男性；AMI 患者 1316 例，稳定型心绞痛患者 1384 例），这些患者均因症状性冠状动脉疾病就诊于一家大型基层医院的急诊室。所有患者均接受了冠状动脉造影。在就诊时或导管实验室采集 copeptin 和其他实验室标志物样本。通过医院病历分析和电话访谈评估临床结局。2621 例患者（97.1%）成功随访 3 个月。主要终点是心血管事件再住院、卒中和全因死亡的复合终点。
使用受试者工作特征曲线，我们计算出 3 个月时复合终点（心肌再梗死、卒中和全因死亡，n=183）的曲线下面积为 0.703（95%置信区间（CI）：0.681-0.725），全因死亡（n=76）的曲线下面积为 0.770（95%CI：0.736-0.803）。复合终点的截定点为 21.6 pmol/L，灵敏度为 56.3%，特异性为 78.6%。cpeptin 的预测性能独立于其他临床变量或心血管危险因素，优于肌钙蛋白 I 或其他心脏标志物（均 P<0.0001）。
copeptin 可能有助于预测有症状 CAD 患者的主要不良心血管事件。进一步的研究应证实这些发现并支持本研究建议的截定点。
