Hodges Gethin W, Bang Casper N, Eugen-Olsen Jesper, Olsen Michael H, Boman Kurt, Ray Simon, Kesäniemi Antero Y, Jeppesen Jørgen L, Wachtell Kristian
Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
Open Heart. 2018 Jan 13;5(1):e000743. doi: 10.1136/openhrt-2017-000743. eCollection 2018.
We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery.
Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period.
Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively.
Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted.
NCT00092677; Post-results.
我们评估了可溶性尿激酶型纤溶酶原激活物受体（suPAR）的早期测量是否能够预测最初无症状的轻中度主动脉瓣狭窄（AS）患者在接受主动脉瓣置换术（AVR）后发生术后并发症的未来风险。
在辛伐他汀和依折麦布治疗主动脉瓣狭窄（SEAS）研究的随访期间，411例接受AVR手术的患者有基线血浆suPAR水平数据。采用Cox分析评估suPAR与全因死亡率以及术后30天内发生的术后并发症复合终点（全因死亡率、充血性心力衰竭、中风和肾功能损害）之间的关系。
初始suPAR水平较高的患者术后死亡风险增加，suPAR每增加一倍，风险比（HR）为3.5（95%置信区间[CI] 1.4至9.0，P = 0.008）；术后并发症风险增加，HR为2.7（95% CI 1.5至5.1，P = 0.002）。在调整欧洲心脏手术风险评估系统或胸外科医师协会风险评分后，suPAR仍与术后死亡率相关，HR分别为3.2（95% CI 1.2至8.6，P = 0.025）和2.7（95% CI 1.0至7.8，P = 0.061）；与术后并发症相关，HR分别为2.5（95% CI 1.3至5.0，P = 0.007）和2.4（95% CI 1.2至4.8，P = 0.011）。
较高的基线suPAR水平与轻中度无症状AS患者接受后期AVR手术后术后并发症和死亡风险增加相关。有必要在其他AS患者亚组中进行进一步验证。
NCT00092677；结果公布后。
