Measuring B-type natriuretic peptides post-operatively improves risk stratification in patients undergoing non-cardiac surgery.

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• Reitze N Rodseth, Bruce M Biccard, Yannick Le Manach, Daniel I Sessler, Giovana A Lurati Buse, Lehana Thabane, Robert C Schutt, Daniel Bolliger, Lucio Cagini, Daniela Cardinale, Carol P W Chong, Rong Chu, Miłosław Cnotliwy, Salvatore Di Somma, René Fahrner, Wen Kwang Lim, Elisabeth Mahla, Ramaswamy Manikandan, Francesco Puma, Wook B Pyun, Milan Radović, Sriram Rajagopalan, Stuart Suttie, Thuvaraha Vanniyasingam, William J van Gaal, Marek Waliszek, and P J Devereaux.
• Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio. Electronic address: ReitzeRodseth@gmail.com.
• J. Am. Coll. Cardiol. 2014 Jan 21;63(2):170-80.

ObjectivesThe 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.BackgroundPre-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.MethodsWe 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.ResultsEighteen 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.ConclusionsAdditional 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.

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