C-terminal provasopressin (copeptin) is a strong prognostic marker in patients with heart failure after an acute myocardial infarction: results from the OPTIMAAL study
C-terminal provasopressin (copeptin) is a strong prognostic marker in patients with heart failure after an acute myocardial infarction: results from the OPTIMAAL study
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DOI：
10.1093/eurheartj/ehp098
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发表时间：
2009-05-01
影响因子：
39.3
通讯作者：
Dickstein, Kenneth
中科院分区：
文献类型：
--
作者：
Voors, Adriaan A.;von Haehling, Stephan;Dickstein, Kenneth
本研究的目的是比较一种新的和肽素，B型利钠肽（BNP）和N-末端BNP前体的预后价值在急性心肌梗死（AMI）后发生心力衰竭的患者中，NT-proBNP对死亡或复合心血管终点的影响。在AMI后平均3天抽取血样，此时所有患者都有心力衰竭的体征和/或症状或左心室射血分数< 0.35。关注的终点为死亡率（OPTIMAAL的主要终点）和复合心血管终点，包括死亡、MI、卒中和/或心脏骤停复苏。平均年龄为67 ± 10岁，平均随访时间为33 ± 7个月。使用单变量考克斯比例风险生存分析，较高水平的和肽素、BNP和NT-proBNP均与死亡率和复合心血管终点显著相关（均P < 0.01）。在多变量考克斯比例风险模型中，包括所有三种生物标志物和其他相关协变量，和肽素加倍与死亡风险增加1.83（1.26-2.64）倍（P < 0.0001）和复合心血管终点风险增加1.35（1.05-1.72）倍（P = 0.018）相关。受试者工作特征曲线表明，与BNP（AUC 0.66; P = 0.0063 vs.和肽素）和NT-proBNP（AUC 0.67; P = 0.0016 vs.和肽素）相比，和肽素[曲线下面积（AUC）0.81]是更强的死亡预测因子。最后，1个月后和肽素水平的变化显著增加了基线值的预后信息。和肽素是AMI后心力衰竭患者死亡率和发病率的一个强有力的新标志物。在该人群中，和肽素的预测价值甚至强于BNP和NT-proBNP。
The aim of the present study was to compare the prognostic value of a novel and promising marker, copeptin, with B-type natriuretic peptide (BNP), and N-terminal pro-BNP (NT-proBNP), on death or a composite cardiovascular endpoint in patients who developed heart failure after an acute myocardial infarction (AMI).From a subset of 224 patients of the OPTIMAAL study, blood samples were drawn at a mean of 3 days after AMI when all patients had signs and/or symptoms of heart failure or a left ventricular ejection fraction < 0.35. Endpoints of interest were mortality (primary endpoint of OPTIMAAL) and a composite cardiovascular endpoint, including death, MI, stroke, and/or resuscitated cardiac arrest. Mean age was 67 +/- 10 years, and mean follow-up was 33 +/- 7 months. Using univariable Cox proportional hazards survival analysis, higher levels of copeptin, BNP, and NT-proBNP were all significantly related to both mortality and the composite cardiovascular endpoint (all P < 0.01). In a multivariable Cox proportional hazards model, including all three biomarkers and other relevant covariates, a doubling of copeptin was related to a 1.83 (1.26-2.64) times increased risk of mortality (P < 0.0001) and a 1.35 (1.05-1.72) times increased risk of the composite cardiovascular endpoint (P = 0.018). Receiver operating characteristic curves indicated that copeptin [area under curve (AUC) 0.81] was a stronger predictor of mortality compared with both BNP (AUC 0.66; P = 0.0063 vs. copeptin) and NT-proBNP (AUC 0.67; P = 0.0016 vs. copeptin). Finally, changes of copeptin levels after 1 month significantly added prognostic information to the baseline value.Copeptin is a strong and novel marker for mortality and morbidity in patients with heart failure after AMI. In this population, the predictive value of copeptin was even stronger than BNP and NT-proBNP.