Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Duceppe, E; Patel, A; Chan, MTV; Berwanger, O; Ackland, G; Kavsak, PA; Rodseth, R; Biccard, B; Chow, CK; Borges, FK; Guyatt, G; Pearse, R; Sessler, DI; Heels-Ansdell, D; Kurz, A; Wang, CY; Szczeklik, W; Srinathan, S; Garg, AX; Pettit, S; Sloan, EN; Januzzi, JL; McQueen, M; Buse, GL; Mills, NL; Zhang, L; Sapsford, R; Pare, G; Walsh, M; Whitlock, R; Lamy, A; Hill, S; Thabane, L; Yusuf, S; Devereaux, PJ.
Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery A Cohort Study
ANN INTERN MED. 2020; 172(2): 96-+.
Doi: 10.7326/M19-2501
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Kurz Andrea
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- Abstract:
- Background: Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. Objective: To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. Design: Prospective cohort study. Setting: 16 hospitals in 9 countries. Results: In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/ mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]). Limitation: External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. Conclusion: Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI.