Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery.
OBJECTIVE
To assess the long-term prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after major vascular surgery.


METHODS
A single-centre prospective cohort study.


METHODS
335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery.


METHODS
Prior to surgery, baseline NT-proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress-induced myocardial ischaemia.


METHODS
The prognostic value of NT-proBNP was evaluated for the endpoints all-cause mortality and major adverse cardiac events (MACE) during long-term follow-up.


RESULTS
In this patient cohort (mean age: 62 years, 76% male), median NT-proBNP level was 186 ng/l (interquartile range: 65-444 ng/l). During a mean follow-up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver operating characteristic curve analysis for 6-month mortality and MACE, NT-proBNP had the greatest area under the curve compared with cardiac risk score and DSE. In addition, an NT-proBNP level of 319 ng/l was identified as the optimal cut-off value to predict 6-month mortality and MACE. After adjustment for age, cardiac risk score, DSE results and cardioprotective medication, NT-proBNP > or =319 ng/l was associated with a hazard ratio of 4.0 for all-cause mortality (95% CI: 1.8 to 8.9) and with a hazard ratio of 10.9 for MACE (95% CI: 4.1 to 27.9).


CONCLUSIONS
Preoperative NT-proBNP level is a strong predictor of long-term mortality and major adverse cardiac events after major non-cardiac vascular surgery.
Feringa
Harm H H
HH
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Schouten
Olaf
O
Dunkelgrun
Martin
M
Bax
Jeroen J
JJ
Boersma
Eric
E
Elhendy
Abdou
A
de Jonge
Robert
R
Karagiannis
Stefanos E
SE
Vidakovic
Radosav
R
Poldermans
Don
D
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D013997:Time Factors
D015415:Biomarkers; D002316:Cardiotonic Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004280:Dobutamine