title: The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients.
abstract: The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p < 0.05 for > 0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with pre-operative B-type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides.
authors:  Principal Specialist.
authors: B M
authors: BM
authors: Biccard
authors:  Specialist, Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital and Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.
authors: G A
authors: GA
authors: Lurati Buse
authors:  Specialist, Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital and Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.
authors: C
authors: C
authors: Burkhart
authors:  Research Fellows, Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors: B H
authors: BH
authors: Cuthbertson
authors:  Professor, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
authors: M
authors: M
authors: Filipovic
authors:  Consultant and Vice Head, Institute for Anaesthesiology, Kantonsspital, St Gallen, Switzerland.
authors: S C
authors: SC
authors: Gibson
authors:  Specialist registrar, West of Scotland Rotation, Stobhill Hospital, Glasgow, Scotland.
authors: E
authors: E
authors: Mahla
authors:  Professor, Univ. Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Graz, Austria.
authors: D W
authors: DW
authors: Leibowitz
authors:  Senior Lecturer, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
authors: R N
authors: RN
authors: Rodseth
mesh_terms: D000368:Aged; D015415:Biomarkers; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D012015:Reference Standards; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain