B-type natriuretic peptide predicts postoperative cardiac events and mortality after elective open abdominal aortic aneurysm repair.
OBJECTIVE
The aim of this study was to determine if a single preoperative B-type natriuretic peptide (BNP) level correlated with perioperative cardiac events, cardiac death, and all-cause mortality in elective open abdominal aortic aneurysm (AAA) repair in the short term, intermediate term, and long term.


METHODS
A prospective, 2-year multicenter observational cohort study in the three vascular units in Glasgow was performed. All patients who were admitted for elective open AAA repair were recruited. Preoperative BNP levels were performed and batch analyzed at the end of the study. Postoperative screening for cardiac events (nonfatal myocardial infarction and cardiac death) was performed at 2, 5, and 30 days. Follow-up for all-cause mortality was sustained to a minimum of 3 years, where possible.


RESULTS
A total of 106 of 111 patients were recruited. Median BNP concentrations were higher in the 16 patients (15%) with immediate postoperative cardiac events (P = .001) and the five with cardiac death (P = .043). Area under the receiver-operating characteristic (AUC) curve analysis indicated BNP concentrations of 99.5 pg/mL best predicted cardiac events (AUC, 0.927), and 448 pg/mL predicted cardiac death (AUC, 0.963). BNP also predicted all-cause mortality in the short-term (P = .028), intermediate-term (P < .001), and long-term (P < .001) postoperative periods.


CONCLUSIONS
Preoperative serum BNP concentration predicted postoperative cardiac events, cardiac death, and all-cause mortality in patients undergoing elective open AAA repair on short-term, intermediate-term, and long-term follow-up on an individual basis with greater accuracy than currently available risk prediction tools.
Department of Vascular Surgery, Western Infirmary, University of Glasgow, Glasgow, United Kingdom. gavinbryce@nhs.net
Gavin J
GJ
Bryce
Christopher J
CJ
Payne
Simon C
SC
Gibson
Dominique S
DS
Byrne
Christian
C
Delles
John
J
McClure
David B
DB
Kingsmore
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000401:mortality / Q000601:surgery*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain