Abstract
ObjectivePrecise perioperative risk stratification is important in vascular surgery patients who are at high risk for major adverse cardiovascular events (MACE) peri- and postoperatively. In clinical practice, the patient’s perioperative risk is predicted by various indicators, e.g. revised cardiac index (RCRI) or modifications thereof. Patients suffering from chronic kidney disease (CKD) are stratified into a higher risk category. We hypothesized that Copeptin as a novel biomarker for hemodynamic stress could help to improve the prediction of perioperative cardiovascular events in patients undergoing vascular surgery including patients with chronic kidney disease.Methods477 consecutive patients undergoing abdominal aortic, peripheral arterial or carotid surgery from June 2007 to October 2012 were prospectively enrolled. Primary endpoint was 30-day postoperative major adverse cardiovascular events (MACE).Results41 patients reached the primary endpoint, including 63.4% aortic, 26.8% carotid, and 9.8% peripheral surgeries. Linear regression analysis showed that RCRI (P< .001), pre- (P< .001), postoperative Copeptin (P< .001) and Copeptin level change (P= .001) were associated with perioperative MACE, but CKD remained independently associated with MACE and Copeptin levels. Multivariate regression showed that increased Copeptin levels added risk predictive information to the RCRI (P= .003). Especially in the intermediate RCRI categories was Copeptin significantly associated with the occurrence of MACE. (P< .05 Kruskal Wallis test). Subdivision of the study cohort into CKD stages revealed that preoperative Copeptin was significantly associated with CKD stages (P< .0001) and preoperative Copeptin measurements could not predict MACE in patients with more severe CKD stages.ConclusionPreoperative Copeptin loses its risk predictive potential for perioperative MACE in patients with chronic kidney disease undergoing vascular surgery.
Highlights
Patients undergoing vascular surgery are prone to perioperative cardiovascular events and progressive organ dysfunction due to an often generalized vascular pathology
Linear regression analysis showed that Revised Cardiac Risk Index (RCRI) (P< .001), pre(P< .001), postoperative Copeptin (P< .001) and Copeptin level change (P= .001) were associated with perioperative major adverse cardiovascular events (MACE), but chronic kidney disease (CKD) remained independently associated with MACE and Copeptin levels
Multivariate regression showed that increased Copeptin levels added risk predictive information to the RCRI (P= .003)
Summary
Patients undergoing vascular surgery are prone to perioperative cardiovascular events and progressive organ dysfunction due to an often generalized vascular pathology. The patients' risk is stratified by using clinical risk scores such as the Revised Cardiac Risk Index (RCRI)[1] and derivations thereof [2,3] In clinical routine these scores are easy to use and they help the physician decide on periand postoperative therapy. These risk scores are useful to compare cohort event rates, but they do not allow sufficient individual risk estimation. This is partly due to the fact that vascular surgery patients accumulate cardiovascular risk factors and many have already experienced cardiovascular events, which will place most of these patients homogenously in higher risk categories of clinical scores [1] making a distinct decision on resource allocation difficult or impossible for the physician
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