title: Prediction of perioperative cardiac events through preoperative NT-pro-BNP and cTnI after emergent non-cardiac surgery in elderly patients.
abstract: OBJECTIVE
  Clinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery. The aim of this study was to determine whether the combined measurement of pre-operative N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) could provide useful prognostic information about postoperative major adverse cardiac events (MACE) within 30 days in patients aged over 60 years undergoing emergent non-cardiac surgery.
  
  
  METHODS
  The study group comprised 2519 patients aged over 60 years that were undergoing emergent non-cardiac surgery between December 2007 and December 2013. NT-pro-BNP and cTnI were measured during hospital admission. The patients were monitored for MACE (cardiac death, non-fatal myocardial infarction, or cardiac arrest) during the 30-day postoperative follow-up period.
  
  
  RESULTS
  MACE occurred in 251 patients (10.0%). Preoperative NT-pro-BNP and cTNI level were significantly higher in the individuals that experienced MACE than in those who did not (P < 0.001). The confounding factors of age, sex, co-morbidities and preoperative medications were adjusted in a multivariate logistic regression analysis. This analysis showed that preoperative NT-proBNP level > 917 pg/mL (OR 4.81, 95% CI 3.446-6.722, P < 0.001) and cTnI ≥ 0.07 ng/mL (OR 8.74, 95% CI 5.881-12.987, P < 0.001) remained significantly and independently associated with MACE after the adjustment of the confounding factors. Kaplan-Meier event-free survival curves demonstrated that patients with preoperative simultaneous NT-proBNP level > 917 pg/mL and cTnT ≥ 0.07 ng/mL had worse event-free survival than individual assessments of either biomarker.
  
  
  CONCLUSIONS
  Preoperative plasma NT-proBNP and cTnI are both independently associated with an increased risk of MACE in elderly patients after emergent non-cardiac surgery. The combination of these biomarkers provides better prognostic information than using either biomarker separately.
authors: Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
authors: Jinling
authors: J
authors: Ma
authors: Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
authors: Qian
authors: Q
authors: Xin
authors: Department of Radiology, Zhaoyuan People's Hospital, Shandong, China.
authors: Xiujie
authors: X
authors: Wang
authors: Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
authors: Meng
authors: M
authors: Gao
authors: Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
authors: Yutang
authors: Y
authors: Wang
authors: Emergency Department, Chinese PLA General Hospital, Beijing, China.
authors: Jie
authors: J
authors: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain