• Emmanuelle Duceppe, Ameen Patel, Chan Matthew T V MTV The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.C., L.Z.)., Otavio Berwanger, Gareth Ackland, Peter A Kavsak, Reitze Rodseth, Bruce Biccard, Clara K Chow, Flavia K Borges, Gordon Guyatt, Rupert Pearse, Daniel I Sessler, Diane Heels-Ansdell, Andrea Kurz, Chew Yin Wang, Wojciech Szczeklik, Sadeesh Srinathan, Amit X Garg, Shirley Pettit, Erin N Sloan, James L Januzzi, Matthew McQueen, Buse Giovanna Lurati GL University Hospital of Düsseldorf, Düsseldorf, Germany (G.L.B.)., Nicholas L Mills, Lin Zhang, Robert Sapsford, Guillaume Paré, Michael Walsh, Richard Whitlock, Andre Lamy, Stephen Hill, Lehana Thabane, Salim Yusuf, and P J Devereaux.
• University of Montreal, Montreal, Québec, and McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (E.D.).
• Ann. Intern. Med. 2020 Jan 21; 172 (2): 96-104.

BackgroundPreliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery.ObjectiveTo 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.DesignProspective cohort study.Setting16 hospitals in 9 countries.Patients10 402 patients aged 45 years or older having inpatient noncardiac surgery.MeasurementsAll patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery.ResultsIn 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%]).LimitationExternal validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings.ConclusionPreoperative 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.Primary Funding SourceCanadian Institutes of Health Research.

27 keywords...

hide…