Postoperative B-type Natriuretic Peptide for Prediction of Major Cardiac Events in Patients Undergoing Noncardiac Surgery Academic Article uri icon

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abstract

  • Abstract Background: It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery. Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more. Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64–0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77–0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74–7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29–7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32–254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55–75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58–4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67–86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05–1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0–9.34; P = 0.022). Patients with BNP values of 0–250, greater than 250–400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0–300, greater than 300–900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively. Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.

authors

  • Rodseth, Reitze N
  • Biccard, Bruce M
  • Chu, Rong
  • Lurati Buse, Giovana A
  • Thabane, Lehana
  • Bakhai, Ameet
  • Bolliger, Daniel
  • Cagini, Lucio
  • Cahill, Thomas J
  • Cardinale, Daniela
  • Chong, Carol PW
  • Cnotliwy, Miłosław
  • Di Somma, Salvatore
  • Fahrner, René
  • Lim, Wen K
  • Mahla, Elisabeth
  • Le Manach, Yannick
  • Manikandan, Ramaswamy
  • Pyun, Wook B
  • Rajagopalan, Sriram
  • Radovic´, Milan
  • Schutt, Robert C
  • Sessler, Daniel I
  • Suttie, Stuart
  • Vanniyasingam, Thuvaraha
  • Waliszek, Marek
  • Devereaux, Philip

publication date

  • August 1, 2013