Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery
- 24 December 2019
- journal article
- research article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 172 (2), 96-+
- https://doi.org/10.7326/m19-2501
Abstract
Preliminary data suggest that preoperative N-terminal pro–B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. 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. Prospective cohort study. 16 hospitals in 9 countries. 10 402 patients aged 45 years or older having inpatient noncardiac surgery. All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery. 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%]). External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. 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. Canadian Institutes of Health Research.Keywords
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