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Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro–B-Type Natriuretic Peptide Measurement an Independent Predictor of Adverse Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery?

Journal of the American College of Cardiology, , Vol.54 (17), p.1599-1606 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2009 American College of Cardiology Foundation ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2009.06.028

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  • Title:
    Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro–B-Type Natriuretic Peptide Measurement an Independent Predictor of Adverse Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery?
  • Author: Karthikeyan, Ganesan, MD, DM ; Moncur, Ross A., BSc ; Levine, Oren, BSc ; Heels-Ansdell, Diane, MSc ; Chan, Matthew T.V., MD, MSc ; Alonso-Coello, Pablo, MD, MSc ; Yusuf, Salim, MBBS, DPhil ; Sessler, Daniel, MD ; Villar, Juan Carlos, MD, PhD ; Berwanger, Otavio, MD, PhD ; McQueen, Matthew, MB, ChB, PhD ; Mathew, Anna, MD ; Hill, Stephen, PhD ; Gibson, Simon, MD ; Berry, Colin, MD ; Yeh, Huei-Ming, MD ; Devereaux, P.J., MD, PhD
  • Subjects: brain natriuretic peptide ; Cardiovascular ; Internal Medicine ; perioperative myocardial infarction ; perioperative risk
  • Is Part Of: Journal of the American College of Cardiology, , Vol.54 (17), p.1599-1606
  • Description: Objectives We conducted a systematic review and meta-analysis to determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or N-terminal pro–B-type natriuretic peptide [NT-proBNP]) is an independent predictor of 30-day adverse cardiovascular outcomes after noncardiac surgery. Background Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting. Methods We employed 5 search strategies (e.g., searching bibliographic databases), and we included all studies that assessed the independent prognostic value of pre-operative BNP measurement as a predictor of cardiovascular complications after noncardiac surgery. We determined study eligibility and conducted data abstraction independently and in duplicate. We calculated a pooled odds ratio using a random effects model. Results Nine studies met eligibility criteria, and included a total of 3,281 patients, among whom 314 experienced 1 or more perioperative cardiovascular complications. The average proportion of patients with elevated BNP was 24.8% (95% confidence interval [CI]: 20.1 to 30.4%; I2 = 89%). All studies showed a statistically significant association between an elevated pre-operative BNP level and various cardiovascular outcomes (e.g., a composite of cardiac death and nonfatal myocardial infarction; atrial fibrillation). Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95% CI: 8.5 to 43.7; I2 = 58%). The pre-operative BNP measurement was an independent predictor of perioperative cardiovascular events among studies that only considered the outcomes of death, cardiovascular death, or myocardial infarction (OR: 44.2, 95% CI: 7.6 to 257.0, I2 = 51.6%), and those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I2 = 62.2%); the p value for interaction was 0.28. Conclusions These results suggest that an elevated pre-operative BNP or NT-proBNP measurement is a powerful, independent predictor of cardiovascular events in the first 30 days after noncardiac surgery.
  • Publisher: Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0735-1097
    EISSN: 1558-3597
    DOI: 10.1016/j.jacc.2009.06.028
  • Source: GFMER Free Medical Journals
    Alma/SFX Local Collection
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