title: N-terminal pro-brain natriuretic peptide identifies patients at high risk for adverse cardiac outcome after vascular surgery.
abstract: BACKGROUND
  Preoperative N-terminal pro-BNP (NT-proBNP) is independently associated with adverse cardiac outcome but does not anticipate the dynamic consequences of anesthesia and surgery. The authors hypothesized that a single postoperative NT-proBNP level provides additional prognostic information for in-hospital and late cardiac events.
  
  
  METHODS
  Two hundred eighteen patients scheduled to undergo vascular surgery were enrolled and followed up for 24-30 months. Logistic regression and Cox proportional hazards model were performed to evaluate predictors of in-hospital and long-term cardiac outcome. The optimal discriminatory level of preoperative and postoperative NT-proBNP was determined by receiver operating characteristic analysis.
  
  
  RESULTS
  During a median follow-up of 826 days, 44 patients (20%) experienced 51 cardiac events. Perioperatively, median NT-proBNP increased from 215 to 557 pg/ml (interquartile range, 83/457 to 221/1178 pg/ml; P<0.001). The optimum discriminate threshold for preoperative and postoperative NT-proBNP was 280 pg/ml (95% confidence interval, 123-400) and 860 pg/ml (95% confidence interval, 556-1,054), respectively. Adjusted for age, previous myocardial infarction, preoperative fibrinogen, creatinine, high-sensitivity C-reactive protein, type, duration, and surgical complications, only postoperative NT-proBNP remained significantly associated with in-hospital (adjusted hazard ratio, 19.8; 95% confidence interval, 3.4-115) and long-term cardiac outcome (adjusted hazard ratio, 4.88; 95% confidence interval, 2.43-9.81).
  
  
  CONCLUSIONS
  A single postoperative NT-proBNP determination provides important additional prognostic information to preoperative levels and may support therapeutic decisions to prevent subsequent structural myocardial damage.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Unit of Medical Engineering and Computing, Medical University of Graz, Austria. elisabeth.mahla@meduni-graz.at
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.forename: Anneliese
authors.initials: A
authors.lastname: Baumann
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Norbert
authors.initials: N
authors.lastname: Watzinger
authors.forename: Martin N
authors.initials: MN
authors.lastname: Vicenzi
authors.forename: Robert
authors.initials: R
authors.lastname: Maier
authors.forename: Kurt
authors.initials: K
authors.lastname: Tiesenhausen
authors.forename: Helfried
authors.initials: H
authors.lastname: Metzler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Toller
mesh_terms: D000368:Aged; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011300:Preoperative Care; D011379:Prognosis; D014656:Vascular Surgical Procedures
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain