Predictive Value Of Copeptin And NT-proBNP For The Short-term Prognosis In Patients With Acute Myocardial Infarction

Objectives To analyze the relationship between plasma level of copeptin and severity of coronary artery disease and to explore the predictive value of copeptin and NT-proBNP detection for short-term clinical outcomes in patients with acute myocardial infarction(AMI).Methods A total of 196 patients in our hospital were selected in the study from February 2015 to August 2015,which including 134 cases of AMI(68 cases of STEMI and 66 cases of NTEMI),and 62 cases of SCAD in the same period were also enrolled which as a control group.Collected general clinical data of all the patients.Using ELISA determination method for the detection of plasma concentrations of copeptin in three groups.Compared the level of copeptin between the three group,to analysis the relationship between copeptin and coronary artery disease severity,and to further explore the predictive value of copeptin and NT-proBNP for the short-term prognosis in patients with AMI.Using Pearson or Spearman correlation analysis method to explore the relationship between copeptin with multiple risk factors for CAD. 6 months follow-up for all AMI patients, check the echocardiography before discharge, 2 weeks, 1 month, 3 months and 6 months,cardiac function and left ventricular remodeling was observed, and record the occurrence of MACE, draw the ROC curve of copeptin and NT-proBNP to predict MACE, calculate the area under the ROC curve(AUC).Results 1. The concentration of copeptin and NT-proBNP in patients with STEMI were higher than that of patients with NSTEMI(t=3.264, P<0.01;t=2.567, P<0.05); the concentration of copeptin and NT-proBNP were significantly higher than that of control group(t=3.156,P<0.01;t=4.548,P<0.01). 2. The plasma level of copeptin and NT-proBNP was positively correlated with the coronary vessel counts and Gensini score(P<0.001).The concentration of copeptin of three vessels disease of coronary was higher than that of single and double-vessel disease, the concentration of copeptin of double vessels disease of coronary was higher than that of single-vessel disease(P<0.01 or P<0.05). 3. The high level of copeptin was positively correlated with FPG, LDLc, hs-CRP and so was the NT-proBNP,and negatively correlated with HDLc,c Tn T.There was no obvious correlation with age, SBP, DBP, TC, TG, CR and UA. The level of copeptin was negatively correlated with LVEF, IVS( r=-0.446,P<0.001;r=-0.192,P=0.024), and was positively correlated with LA, LVEDd(r=0.352?0.479,P<0.01), and there was no obvious correlation LVPW(P >0.05). 4. A multiple Cox regression analysis showed that the high level of copeptin, NT-proBNP and Gensini score was risk factors of MACE.There was no significant difference between the distinguish accuracy of copeptin and NT-proBNP for 6 months MACE([AUC=0.883(0.774-0.992),0.843(0.705-0.969)],P=0.126),but the combined detection of copeptin and NT-proBNP has a good prediction accuracy than single detection of NT-proBNP or copeptin[AUC=0.901(0.765–0.996),P=0.020?0.034].Conclusions 1. The concentration of copeptin was significantly increased in patients with AMI when compared with SCAD(P<0.05); the concentration of copeptin and NT-proBNP in patients with STEMI were higher than that of NSTEM(P<0.05). It has a significant correlation between the level of copeptin and NT-proBNP and the coronary artery disease. 2. The plasma level of copeptin was positively related with FPG, LDLc, hs-CRP, LA, LVEDd NT-proBNP,and negatively correlated with HDLc,c Tn T,LVEF,IVS.The prediction accuracy for MACE was higher when combined detection of copeptin and NT-proBNP which suggested that the predictive value for the short-term prognosis was also higer.