Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: a prospective study.
OBJECTIVE
Brain natriuretic peptide (BNP) levels correlate with prognosis in patients with cardiac disease and may be useful in the risk stratification of cardiac patients undergoing noncardiac surgery (NCS). The objective of this study was to examine whether BNP levels predict perioperative events in cardiac patients undergoing NCS.


METHODS
Patients undergoing NCS with at least 1 of the following criteria were included: a clinical history of congestive heart failure (CHF), ejection fraction <40%, or severe aortic stenosis. All patients underwent echocardiography and measurement of BNP performed using the ADVIA-Centaur BNP assay (Bayer HealthCare). Clinical endpoints were death, myocardial infarction or pulmonary congestion requiring intravenous diuretics at 30 days of follow-up.


RESULTS
Forty-four patients were entered into the study; 15 patients (34%) developed cardiac postoperative complications. The mean BNP level was 1,366 +/- 1,420 pg/ml in patients with events and 167 +/- 194 pg/ml in patients without events, indicating a highly significant difference (p < 0.001). The ROC area under the curve was 0.91 (95% CI 0.83-0.99) with an optimal cutoff of >165 pg/ml (100% sensitivity, 70% specificity).


CONCLUSIONS
BNP levels may predict perioperative complications in cardiac patients undergoing NCS, and the measurement of BNP should be considered to assess the preoperative cardiac risk.
Leibowitz
David
D
Departments of Cardiology and Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. oleibo@hadassah.org.il
Planer
David
D
Rott
David
D
Elitzur
Yair
Y
Chajek-Shaul
Tova
T
Weiss
A Teddy
AT
D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000401:mortality; D006333:Heart Failure / Q000097:blood / Q000150:complications; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative
D020097:Natriuretic Peptide, Brain