title: Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies.
abstract: OBJECTIVE
  We conducted a systematic review and meta-analysis to determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) is an independent predictor of 30-day adverse cardiovascular outcomes after noncardiac surgery.
  
  
  BACKGROUND
  Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting.
  
  
  METHODS
  We employed 5 search strategies (e.g., searching bibliographic databases), and we included all studies that assessed the independent prognostic value of pre-operative BNP measurement as a predictor of cardiovascular complications after noncardiac surgery. We determined study eligibility and conducted data abstraction independently and in duplicate. We calculated a pooled odds ratio using a random effects model.
  
  
  RESULTS
  Nine studies met eligibility criteria, and included a total of 3,281 patients, among whom 314 experienced 1 or more perioperative cardiovascular complications. The average proportion of patients with elevated BNP was 24.8% (95% confidence interval [CI]: 20.1 to 30.4%; I(2) = 89%). All studies showed a statistically significant association between an elevated pre-operative BNP level and various cardiovascular outcomes (e.g., a composite of cardiac death and nonfatal myocardial infarction; atrial fibrillation). Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95% CI: 8.5 to 43.7; I(2) = 58%). The pre-operative BNP measurement was an independent predictor of perioperative cardiovascular events among studies that only considered the outcomes of death, cardiovascular death, or myocardial infarction (OR: 44.2, 95% CI: 7.6 to 257.0, I(2) = 51.6%), and those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I(2) = 62.2%); the p value for interaction was 0.28.
  
  
  CONCLUSIONS
  These results suggest that an elevated pre-operative BNP or NT-proBNP measurement is a powerful, independent predictor of cardiovascular events in the first 30 days after noncardiac surgery.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.forename: Ross A
authors.initials: RA
authors.lastname: Moncur
authors.forename: Oren
authors.initials: O
authors.lastname: Levine
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Matthew T V
authors.initials: MT
authors.lastname: Chan
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Daniel
authors.initials: D
authors.lastname: Sessler
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Villar
authors.forename: Otavio
authors.initials: O
authors.lastname: Berwanger
authors.forename: Matthew
authors.initials: M
authors.lastname: McQueen
authors.forename: Anna
authors.initials: A
authors.lastname: Mathew
authors.forename: Stephen
authors.initials: S
authors.lastname: Hill
authors.forename: Simon
authors.initials: S
authors.lastname: Gibson
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Huei-Ming
authors.initials: HM
authors.lastname: Yeh
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain