Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Predictive of Perioperative Cardiac Events in Patients Undergoing Vascular Surgery.
10.3904/kjim.2012.27.3.301
- Author:
Ji Hyun YANG
1
;
Jin Ho CHOI
;
Young Wook KI
;
Dong Ik KIM
;
Duk Kyung KIM
;
Jeong Rang PARK
;
Jae K OH
;
Seung Hyuk CHOI
Author Information
1. Division of Cardiology, Department of Internal Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.
- Publication Type:Original Article
- Keywords:
Pro-B-type natriuretic peptide;
Vascular surgical procedures;
Postoperative complications
- MeSH:
Aged;
Biological Markers/blood;
Chi-Square Distribution;
Female;
Heart Diseases/blood/*etiology/mortality;
Heart Failure/etiology;
Humans;
Logistic Models;
Male;
Middle Aged;
Multivariate Analysis;
Myocardial Infarction/etiology;
Natriuretic Peptide, Brain/*blood;
Odds Ratio;
Peptide Fragments/*blood;
Predictive Value of Tests;
Preoperative Period;
Prospective Studies;
ROC Curve;
Risk Assessment;
Risk Factors;
Sensitivity and Specificity;
Surgical Procedures, Elective;
Time Factors;
Tomography, Emission-Computed, Single-Photon;
Treatment Outcome;
Vascular Diseases/blood/mortality/radionuclide imaging/*surgery;
Vascular Surgical Procedures/*adverse effects/mortality
- From:The Korean Journal of Internal Medicine
2012;27(3):301-310
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. METHODS: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (> or = 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. RESULTS: A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NT-proBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. CONCLUSIONS: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.
