Abstract 21285: Copeptin and Nt-proBNP as Precitors of Post-operative Outcome in Patients with Major Vascular Surgery
Background and Aim: Nt-proBNP is a well described predictor of postoperative outcome after elective surgery. Copeptin, the C-terminal part of the pro-vasopressin peptide, has been shown to predict clinical outcome of patients with acute myocardial infarction. In the present study we investigated whether the pre-operative determination of plasma copeptin levels might improve risk stratification for high-risk patients undergoing major vascular surgery on top of plasma Nt-proBNP.
Methods: 198 consecutive patients undergoing major vascular surgery (58.6% infra-inguinal aortic reconstruction, 23.7% abdominal aortic aneurysm surgery, 17.7% carotid endarterectomy) were included in the present study. Patients were monitored for in-hospital and long-term (2-years) major adverse cardiac events (MACE: cardiac death, myocardial infarction and emergent coronary revascularization).
Results: 41 (21%) patients had elevated copeptin levels (>16.4pmol/l) prior to surgery. In these patients the combined MACE rate was significantly higher (41.5% vs. 15.2% p<0.001) and elevated copeptin levels were associated with a 3.3-fold increased risk for worse clinical outcome (p<0.001). In multivariate Cox regression analysis — adjusted for the type of surgery, age, sex, NYHA and CCS Classes, hs-CRP, history of heart failure, myocardial infarction and TIA/Stroke, pre-op. LVEF and Nt-proBNP — elevated Copeptin concentrations were independently associated with increased risk for cardiac events in addition to Nt-proBNP (HR: 1.03 p<0.001). Copeptin concentrations of >16.4pmol/l were significant determinants of outcome among patients with or without elevated Nt-proBNP (Figure).
Conclusions: Our results suggest that the pre-operative determination of copeptin concentrations might substantially improve the estimation of post-operative outcome after major vascular surgery and therefore help to define patients of high-risk for post-operative complications.
- © 2010 by American Heart Association, Inc.