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

Author:

Rodseth Reitze N.1,Biccard Bruce M.2,Chu Rong3,Lurati Buse Giovana A.4,Thabane Lehana5,Bakhai Ameet6,Bolliger Daniel7,Cagini Lucio8,Cahill Thomas J.9,Cardinale Daniela10,Chong Carol P. W.11,Cnotliwy Miłosław12,Di Somma Salvatore13,Fahrner René14,Lim Wen K.15,Mahla Elisabeth16,Le Manach Yannick17,Manikandan Ramaswamy18,Pyun Wook B.19,Rajagopalan Sriram20,Radovic´ Milan21,Schutt Robert C.22,Sessler Daniel I.23,Suttie Stuart24,Vanniyasingam Thuvaraha25,Waliszek Marek26,Devereaux P. J.27

Affiliation:

1. Lecturer, Perioperative Research Group, Department of Anaesthetics, Inkosi Albert Luthuli Central Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Research Fellow, Population Health Research Institute, Hamilton, Ontario, Canada; and Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

2. Honorary Associate Professor, Perioperative Research Group, Department of Anaesthetics, Inkosi Albert Luthuli Central Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal.

3. Statistician, Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences

4. Anaesthetic Consultant

5. Professor, Departments of Clinical Epidemiology and Biostatistics/Anesthesia/Pediatrics, McMaster University; Director, Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario, Canada; and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.

6. Consultant Cardiologist and Trust R&D Director, Barnet and Chase Farm Hospital NHS Trust, Barnet Hospital, Barnet, United Kingdom.

7. Assistant Professor, Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.

8. Consultant Surgeon, Department of Surgical Science, University of Perugia, Ospedale S.Maria, Perugia, Italy.

9. Academic Clinical Fellow, Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.

10. Director, Cardioncology Unit, European Institute of Oncology, Milan, Italy.

11. Research Fellow and Geriatrician

12. Associate Professor, Department of Vascular and General Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland.

13. Associate Professor, Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza and Emergency Department, Sant’Andrea Hospital, Rome, Italy.

14. Consultant Surgeon, Division of Visceral Surgery and Medicine, University Hospital Berne, Inselspital Berne, Bern, Switzerland.

15. Associate Professor, Departments of Aged Care, Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia, and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Victoria, Australia.

16. Associate Professor, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria.

17. Assistant Professor, Departments of Anesthesia, Clinical Epidemiology and Biostatistics

18. Consultant Urological Surgeon, Departments of Urology, Stepping Hill Hospital, Stockport and Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom.

19. Associate Professor, Divison of Cardiology, Department of Internal Medicine, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea.

20. Consultant Surgeon, Department of Vascular Surgery, University of Aberdeen and Aberdeen Royal Infirmary, NHS Grampian, Foresterhill, Aberdeen, United Kingdom.

21. Professor of Internal Medicine/Nephrology, University of Belgrade, School of Medicine, Belgrade, Serbia.

22. Assistant Professor, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia.

23. Michael Cudahy Professor and Chair, Department of Outcomes Research, Cleveland Clinic.

24. Consultant Vascular Surgeon, Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.

25. Masters Candidate, Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada.

26. Head of Cardiac Diagnostics Unit, M. Pirogow Provincial Specialist Hospital, Lodz, Poland.

27. Associate Professor, Departments of Medicine, Clinical Epidemiology and Biostatistics, Population Health Research Institute, Hamilton Health Sciences.

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

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