Usefulness of Pre-Operative Copeptin Concentrations to Predict Post-Operative Outcome After Major Vascular Surgery

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• 作者：Rudolf Jarai ; MD^a ; Elisabeth Mahla ; MD^b ; Thomas Perkmann ; MD^c ; Robert Jarai ; PhD^d ; Sylvia Archan ; MD^b ; Ioannis Tentzeris ; MD^a ; Kurt Huber ; MD^a ; ^{kurt.huber@wienkav.at} ; Helfried Metzler ; MD^b
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 October, 2011
• 年：2011
• 卷：108
• 期：8
• 页码：1188-1195
• 全文大小：1K

文摘

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.