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SHR Neuro Cancer Cardio Lipid Metab Microb
Rodseth, RN; Biccard, BM; Le Manach, Y; Sessler, DI; Lurati Buse, GA; Thabane, L; Schutt, RC; Bolliger, D; Cagini, L; Cardinale, D; Chong, CP; Chu, R; Cnotliwy, M; Di Somma, S; Fahrner, R; Lim, WK; Mahla, E; Manikandan, R; Puma, F; Pyun, WB; Radović, M; Rajagopalan, S; Suttie, S; Vanniyasingam, T; van Gaal, WJ; Waliszek, M; Devereaux, PJ.
The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis.
J Am Coll Cardiol. 2014; 63(2):170-180
Doi: 10.1016/j.jacc.2013.08.1630
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- Co-authors Med Uni Graz
- Mahla Elisabeth
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- Abstract:
- The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Biological Markers - blood
- Cardiovascular Diseases - blood
- Humans -
- Incidence -
- Natriuretic Peptide, Brain - blood
- Peptide Fragments - blood
- Postoperative Complications - blood
- Postoperative Period -
- Preoperative Period -
- Prognosis -
- Surgical Procedures, Operative -
- World Health -
- Find related publications in this database (Keywords)
- anesthesia
- myocardial infarction
- natriuretic peptides
- risk factors
- surgery