11 Copeptin improves early risk stratification by Grace Score in non ST-elevation myocardial infarction; NT-proBNP does not

BackgroundRisk stratification is vital to the optimal management of patients with non ST-elevation myocardial infarction (NSTEMI) however, current tools are not fully discriminatory. Copeptin, the stable 39 amino acid C-terminal portion of pro-vasopressin, is a recognised prognostic marker in ST elevation myocardial infarction (STEMI) that is also useful to exclude MI as levels rise early after onset. Copeptin has not been evaluated in a NSTEMI population to date.AimsWe hypothesised that copeptin is an independent predictor of mortality following NSTEMI and, in accordance with AHA criteria for the evaluation of novel biomarkers, assess whether copeptin adds prognostic information to GRACE risk score (GRACE-RS). We use NT-proBNP for comparison.Methods and ResultsIn this prospective observational study plasma copeptin and NT-proBNP was measured in 754 NSTEMI patients (519 men, median age 70±13 years) within 36 h of symptoms. The primary endpoint of all-cause mortality at 6 months was reached by 56 (7.4%) patients. Median copeptin levels were 7.9 range 0.3 to 523.0 pmol/l and were significantly higher in those that reached the primary endpoint than the event free survivors; median (IQR), 32.0 (12.0–88.7) vs 7.2 (4.0–16.7) respectively p