Abstract |
The aim of this study was to investigate whether preoperative determination of plasma copeptin levels in addition to plasma N-terminal pro- B-type natriuretic peptide (NT-pro-BNP) could help improve risk stratification in patients who undergo major vascular surgery. One hundred ninety-eight consecutive patients who underwent major vascular surgery (58.6% infrainguinal aortic reconstruction, 23.7% abdominal aortic aneurysm surgery, 17.7% carotid endarterectomy) were included in this study. Patients were monitored for in-hospital and long-term (2-years) major adverse cardiac events, consisting of cardiac death, nonfatal myocardial infarction, and emergent coronary revascularization. Overall, 40 patients (20.2%) reached the primary end point, and most of these events occurred during the index hospital stay (n = 18 [45%]). In univariate Cox regression analysis, increasing concentrations of copeptin were significant determinants of outcome as a continuous variable (hazard ratio [HR] 1.012, p = 0.005) and as a dichotomized variable according to the recommended cutoff of 14.0 pmol/L (HR 4.116, p <0.001). Subgroup analyses revealed that especially patients at low estimated risk according to plasma NT-pro-BNP levels were at significantly higher risk for worse outcomes with higher copeptin levels (HR 5.983, p = 0.002). In multivariate Cox regression analysis, copeptin concentrations >14 pmol/L were significant independent predictors of outcome (HR 2.842, p = 0.002) in addition to type of surgery, history of myocardial infarction, elevated levels of cardiac troponin T, and NT-pro-BNP levels. In conclusion, the results of this study suggest that preoperative determination of this new biomarker could substantially improve prediction of perioperative and postoperative outcomes in vascular surgery patients.
|
Authors | Rudolf Jarai, Elisabeth Mahla, Thomas Perkmann, Robert Jarai, Sylvia Archan, Ioannis Tentzeris, Kurt Huber, Helfried Metzler |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 108
Issue 8
Pg. 1188-95
(Oct 15 2011)
ISSN: 1879-1913 [Electronic] United States |
PMID | 21798504
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright © 2011 Elsevier Inc. All rights reserved. |
Chemical References |
- Biomarkers
- Glycopeptides
- Protein Precursors
- copeptins
|
Topics |
- Aged
- Austria
(epidemiology)
- Biomarkers
(blood)
- Female
- Follow-Up Studies
- Glycopeptides
(blood)
- Humans
- Incidence
- Male
- Postoperative Complications
(blood, epidemiology)
- Predictive Value of Tests
- Preoperative Care
(methods)
- Prevalence
- Prognosis
- Prospective Studies
- Protein Precursors
- Risk Assessment
(methods)
- Vascular Diseases
(blood, surgery)
- Vascular Surgical Procedures
|