Plasma N-terminal Pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery

Ji Hyun Yang, Jin Ho Choi, Young Wook Ki, Dong Ik Kim, Duk Kyung Kim, Jeong Rang Park, Jae Kuen Oh, Seung Hyuk Choi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background/Aims: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. Methods: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (≥ 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. Results: A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/ mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NTproBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. Conclusions: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.

Original languageEnglish (US)
Pages (from-to)301-310
Number of pages10
JournalKorean Journal of Internal Medicine
Volume27
Issue number3
DOIs
StatePublished - Sep 2012

Fingerprint

Brain Natriuretic Peptide
Blood Vessels
Thallium
Perfusion
Odds Ratio
Confidence Intervals
Pulmonary Edema
Ambulatory Surgical Procedures
Area Under Curve
Ischemia
Heart Failure
Myocardial Infarction

Keywords

  • Postoperative complications
  • Pro-B-type natriuretic peptide
  • Vascular surgical procedures

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Plasma N-terminal Pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery. / Yang, Ji Hyun; Choi, Jin Ho; Ki, Young Wook; Kim, Dong Ik; Kim, Duk Kyung; Park, Jeong Rang; Oh, Jae Kuen; Choi, Seung Hyuk.

In: Korean Journal of Internal Medicine, Vol. 27, No. 3, 09.2012, p. 301-310.

Research output: Contribution to journalArticle

Yang, Ji Hyun ; Choi, Jin Ho ; Ki, Young Wook ; Kim, Dong Ik ; Kim, Duk Kyung ; Park, Jeong Rang ; Oh, Jae Kuen ; Choi, Seung Hyuk. / Plasma N-terminal Pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery. In: Korean Journal of Internal Medicine. 2012 ; Vol. 27, No. 3. pp. 301-310.
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abstract = "Background/Aims: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. Methods: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (≥ 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. Results: A total of 365 patients (91{\%} males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/ mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4{\%}) patients. After adjustment for confounders, an NTproBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95{\%} confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95{\%} CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. Conclusions: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.",
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T1 - Plasma N-terminal Pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery

AU - Yang, Ji Hyun

AU - Choi, Jin Ho

AU - Ki, Young Wook

AU - Kim, Dong Ik

AU - Kim, Duk Kyung

AU - Park, Jeong Rang

AU - Oh, Jae Kuen

AU - Choi, Seung Hyuk

PY - 2012/9

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N2 - Background/Aims: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. Methods: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (≥ 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. Results: A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/ mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NTproBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. Conclusions: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.

AB - Background/Aims: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. Methods: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (≥ 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. Results: A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/ mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NTproBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. Conclusions: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.

KW - Postoperative complications

KW - Pro-B-type natriuretic peptide

KW - Vascular surgical procedures

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