Korean J Intern Med.  2012 Sep;27(3):301-310. 10.3904/kjim.2012.27.3.301.

Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Predictive of Perioperative Cardiac Events in Patients Undergoing Vascular Surgery

• Yang JH
• Choi JH
• Ki YW
• Kim DI
• Kim DK
• Park JR
• Oh JK
• Choi SH

• KMID: 1776522
• DOI: http://doi.org/10.3904/kjim.2012.27.3.301

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.

Keyword

Pro-B-type natriuretic peptide; Vascular surgical procedures; Postoperative complications

MeSH Terms

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