Plasma N-terminal prohormone brain natriuretic peptide as a marker for postoperative cardiac events in high-risk patients undergoing noncardiac surgery.
This study considered if N-terminal prohormone brain natriuretic peptide (NT-proBNP) is associated with increased risk for postoperative cardiac events in high-risk patients undergoing noncardiac surgery. In addition, this report describes how levels of NT-proBNP are affected by noncardiac surgery. The study design was a prospective cohort study that enrolled 83 patients age > or =50 years with > or =1 risk factor for coronary artery disease having intermediate or high-risk noncardiac surgery. NT-proBNP levels were measured preoperatively and on postoperative days 1 and 3. During the month following surgery, 25 patients (33%) had a combined 37 postoperative cardiac events including 15 episodes of heart failure (20%), 12 episodes of new dysrhythmia (16%), 7 myocardial infarctions (9%), and 3 cardiac arrests (4%). Preoperative NT-proBNP level > or =457 pg/ml was significantly associated with occurrence of a postoperative cardiac event (odds ratio 10.5, 95% confidence interval 1.9 to 56.6, p = 0.006). After surgery, 64 of 72 patients (89%) had an increase in NT-proBNP from their preoperative level. In conclusion, this study determined there was a significant association between elevated preoperative NT-proBNP and occurrence of a postoperative cardiac event. In addition, increased NT-proBNP after noncardiac surgery is not uncommon even in the absence of clinically identifiable heart failure.
Schutt
Robert Clark
RC
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA. rob.schutt@gmail.com
Cevik
Cihan
C
Phy
Michael P
MP
D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain