title: Prognostic value of perioperative N-terminal pro-B-type natriuretic peptide in noncardiac surgery.
abstract: BACKGROUND
  Preoperative NT-proBNP has been shown to predict adverse cardiac outcomes, although recent studies suggested that postoperative NT-proBNP determination could provide additional information in patients submitted to noncardiac surgery.
  
  
  OBJECTIVE
  To evaluate the prognostic value of perioperative NT-proBNP in intermediate and high risk cardiovascular patients undergoing noncardiac surgery.
  
  
  METHODS
  This study prospectively enrolled 145 patients aged ≥ 45 years, with at least one Revised Cardiac Risk Index risk factor and submitted to intermediate or high risk noncardiac surgery. NT-proBNP levels were measured pre- and postoperatively. Short-term cardiac outcome predictors were evaluated by logistic regression models.
  
  
  RESULTS
  During a median follow-up of 29 days, 17 patients (11.7%) experienced major adverse cardiac events (MACE- 14 nonfatal myocardial infarctions, 2 nonfatal cardiac arrests and 3 cardiac deaths). The optimum discriminatory threshold levels for pre- and postoperative NT-proBNP were 917 and 2962 pg/mL, respectively. Pre- and postoperative NT-proBNP (OR 4.7; 95% CI 1.62-13.73; p=0.005 and OR 4.5; 95% CI 1.53-13.16; p=0.006) were significantly associated with MACE. Preoperative NT-proBNP was significantly and independently associated with adverse cardiac events in multivariate regression analysis (adjusted OR 4.2; 95% CI 1.38-12.62; p=0.011).
  
  
  CONCLUSIONS
  NT-proBNP is a powerful short-term marker of perioperative cardiovascular events in high risk patients. Postoperative levels were less informative than preoperative levels. A single preoperative NT-proBNP measurement should be considered in the preoperative risk assessment.
authors: Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. flaviakessler@terra.com.br
authors: Flávia Kessler
authors: FK
authors: Borges
authors: Mariana Vargas
authors: MV
authors: Furtado
authors: Ana Paula Webber
authors: AP
authors: Rossini
authors: Carolina
authors: C
authors: Bertoluci
authors: Vinícius Leite
authors: VL
authors: Gonzalez
authors: Eduardo Gehling
authors: EG
authors: Bertoldi
authors: Denis Maltz
authors: DM
authors: Grutcki
authors: Leandro Gazziero
authors: LG
authors: Rech
authors: Mariana
authors: M
authors: Magalhães
authors: Carisi Anne
authors: CA
authors: Polanczyk
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D059035:Perioperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain