title: Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class.
abstract: BACKGROUND
  The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date.
  
  
  METHODS
  The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge.
  
  
  RESULTS
  MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point ≥ 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point ≥ 69 pg/mL gave an AUC of 0.82.
  
  
  CONCLUSIONS
  Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, P,le S, M, della Misericordia 15, ZIP code: 33100 Udine, Italy. vetrugno.luigi@aoud.sanita.fvg.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vetrugno
authors.forename: Nicola
authors.initials: N
authors.lastname: Langiano
authors.forename: Renato
authors.initials: R
authors.lastname: Gisonni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rizzardo
authors.forename: Paola Enrica
authors.initials: PE
authors.lastname: Venchiarutti
authors.forename: Michele
authors.initials: M
authors.lastname: Divella
authors.forename: Livia
authors.initials: L
authors.lastname: Pompei
authors.forename: Araldo
authors.initials: A
authors.lastname: Causero
authors.forename: Giorgio Della
authors.initials: GD
authors.lastname: Rocca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000592:standards; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain