Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients.
OBJECTIVE
To evaluate the predictive value of brain natriuretic peptide (BNP) for assessment of cardiac risk before non-cardiac surgery.


METHODS
Consecutively treated patients (947 men, 643 women) whose BNP was measured before non-cardiac surgery were studied. Clinical and ECG variables were evaluated to identify predictors of postoperative cardiac events.


RESULTS
Events occurred in 6% of patients: 21 cardiac deaths, 20 non-fatal myocardial infarctions, 41 episodes of pulmonary oedema and 14 patients with ventricular tachycardia. All of these patients had raised plasma BNP concentrations (best cut-off point 189 pg/ml). The only independent predictor of postoperative events was BNP (odds ratio 34.52, 95% confidence interval (CI) 17.08 to 68.62, p < 0.0001). Clinical variables of Goldman's multifactorial index identified 18% of patients in class I, 40% in class II, 24% in class III and 18% in class IV preoperatively; postoperative event rates were 2%, 3%, 7% and 14%, respectively. BNP identified 60% of patients as having zero risk (BNP 0-100 pg/ml), 22% low risk (101-200 pg/ml), 14% intermediate risk (201-300 pg/ml) and 4% high risk (> 300 pg/ml); postoperative event rates were 0%, 5%, 12% and 81%, respectively.


CONCLUSIONS
In this population of patients evaluated before non-cardiac surgery, BNP is an independent predictor of postoperative cardiac events. BNP > 189 pg/ml identified patients at highest risk.
Dernellis
J
J
Department of Cardiology, Vostanion Hospital, Mytilini, Greece . dernellis@yahoo.gr
Panaretou
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011183:Postoperative Complications / Q000097:blood* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity
D020097:Natriuretic Peptide, Brain