Abstract
Background 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. Methods Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during followup 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. Results 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. Conclusion 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.
Original language | English |
---|---|
Article number | e000743 |
Journal | Open Heart |
Volume | 5 |
Issue number | 1 |
DOIs | |
Publication status | Published - Feb 2018 |
Funding
Foundation, whose research grant facilitated the writing of this article. Contributors All authors made substantial contributions to the conception, design and analysis of this work and were involved in the revision and final approval of the version to be published. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding This study was partly funded by the Novo Nordisk Foundation. Competing interests JEO is a co-founder and shareholder of ViroGates A⁄S, Denmark, the company that produces the suPARnostic assay. He is a co-inventor on patents on suPAR and risk. Copenhagen University Hospital Hvidovre, Denmark, owns the patents, which are licensed to ViroGates A⁄S. KB, SR, AYK and KW served on the SEAS Steering Committee were investigators and members of the steering committees of the SEAS study and have received honoraria from Merck & Co, the sponsor of the SEAS study. KB, SR and KW have received grant support from Merck & Co, the sponsor of the SEAS study. AYK reported Speaker's fee from Abbott, MSD and Novo Nordisk, Consult for MSD, research funding from MSD and ownership of Orion Pharma stock. ethics approval The ethical committees of all participating countries (Norway, Sweden, Denmark, Finland, Germany, the United Kingdom, and Ireland) approved the study (the SEAS study is registered at http://ClinicalTrials.gov, identifier NCT00092677). Provenance and peer review Not commissioned; externally peer reviewed.