Cardiotrophin-1 predicts death or heart failure following acute myocardial infarction

Background: Cardiotrophin-1 (CT-1) is an important inflammatory cytokine, its presence has been documented in patients following acute myocardial infarction (AMI). However its role as a predictor of death or heart failure is unclear. We sought to investigate this and compared it to N terminal pro B type natriuretic peptide (NT-proBNP), a marker of death or heart failure Methods: We studied 291 post AMI patients. The plasma concentration of CT-1 and NT-proBNP was determined using in-house non-competitive immunoassays and patients followed-up for death or heart failure Results: There were 27 deaths and 19 readmissions with heart failure. CT-1 was raised in patients with death or heart failure compared to survivors (median [range] fmol/ml, 0.9[0.1-392.2] vs. 0.67[0-453.3], p=0.019). Using a multivariate binary logistic model CT-1 (OR 1.8, 95% CI: 1.1-3.2, p=0.031) and NT-proBNP (OR 2.4, 95% CI: 1.1-5.2, p=0.026) predicted death or heart failure independently of age, sex, previous AMI, serum creatinine and Killip class. The receiver-operating curve for CT-1 yielded an area under the curve (AUC) of 0.62 (95% CI: 0.53-0.70, p=0.017) for NT-proBNP the AUC was 0.77 (95% CI: 0.69-0.86, p<0.001); the logistic model combining the 2 markers yielded an AUC of 0.84 (95% CI: 0.78-0.91, p<0.001). Conclusion: After an AMI, combined levels of CT-1 and NT-proBNP are more informative at predicting death or heart failure than either marker alone.