Predictive value of copeptin in the development of severe heart failure in patients with acute coronary syndrome without ST-segment elevation

The authors present data on the role of new biochemical marker copeptin as the C-end part of the pro-vasopressin, in assessing the risk of severe heart failure in short observation period (30 days) in patients with acute coronary syndrome (ACS) without ST-segment elevation the first 3:00 from the manifestation of pain combined with the definition of the levels of troponin T. Materials and methods. Prospective single center study included 128 patients (including 52 persons with acute myocardial infarction (AMI) diagnosis, 58 persons with unstable angina pectoris and 18 people with unconfirmed coronary event) with suspected ACS without ST-segment elevation with risk factors for coronary heart disease, selected according to criteria of inclusion/exclusion, received information on the study and gave their written consent to participate. Within the framework of the study, levels of troponin T and copeptin were determined for every patient at the admission, a diagnostic test of troponin T was repeated in 12-72 hours. During hospitalization, all patients were subjected to medical diagnostic examination, laboratory diagnosis, drug therapy, prescribed by standards of care, including medical history and analysis of the medical records, registration of ECG, echocardiography, quantitative determination of troponin T, assessment of left ventricular failure on a scale Killip and level of copeptin. Results. The level of copeptin during the early 3 hours since the manifestation of pain identified a direct correlation (r=0.76) between the values of the Copeptin upon receipt and the exacerbation of severity of congestive heart failure (HF) Killip classification established in patients with AMI in the period of hospital treatment and 30-day observation period. The level of copeptin during the early 3 hours since the manifestation of pain was 2.99 ng/ml (95% confidence interval - CI 1.89-4.09) for patients with HF class Killip 3 and 5.57 ng/ml (95% CI 5.08-6.06) for patients with HF class Killip 4 respectively. The level of copeptin ≥2.95 ng/ml significantly increase the risk of severe HF in 11 times - relative risk 11.4 (5.64-22.9, p<0.0001) compared with patients who have level of copeptin below the diagnostic slice - relative risk 0.15 (0.04-0.56), with negative prognostic value of 98% (95% CI 93.00-99.45), specificity 92.45% (95% CI 85.81-96.13, precision 91.67% (95% CI 84.99-95.53) and sensitivity 85.71% (95% CI 60.06-95.99). Conclusions. The level of copeptin ≥2.95 ng/ml, which is defined the first 3:00 from the manifestation of pain syndrome is an important prognostic marker for risk of severe congestive heart failure and an independent prognostic factor in outcome in patients with ACS without ST-segment elevation.

copeptin, acute coronary syndrome without ST-segment elevation, acute myocardial infarction, heart failure, troponin T