Preoperative <i>N</i>-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery

Duceppe, Emmanuelle; Patel, Ameen; Chan, Matthew T. V.; Berwanger, Otávio; Ackland, Gareth L.; Kavsak, Peter A.; Rodseth, Reitze; Biccard, Bruce; Chow, Clara K; Borges, Flávia Kessler; Guyatt, Gordon; Pearse, Rupert M; Sessler, Daniel I.; Heels‐Ansdell, Diane; Kurz, Andrea; Wang, Chew Yin; Szczeklik, Wojciech; Srinathan, Sadeesh; Garg, Amit X.; Pettit, Shirley; Sloan, Erin N.; Januzzi, James L.; McQueen, Matthew; Buse, Giovanna Lurati; Mills, Nicholas L; Zhang, Lin; Sapsford, Robert J; Paré, Guillaume; Walsh, Michael; Whitlock, Richard; Lamy, André; Hill, Stephen A.; Thabane, Lehana; Yusuf, Salim; Devereaux, P.J.

doi:10.7326/m19-2501

Cited by 126 publications

(73 citation statements)

References 27 publications

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“…However, a large observational cohort study suggests that an abnormal (raised) preoperative NP level is an important independent predictor of postoperative cardiovascular RESEARCH morbidity and mortality. [14] We therefore believe that our findings are of clinical relevance in preoperative cardiovascular risk stratification in SA.…”

Section: Study Strengths and Limitationsmentioning

confidence: 57%

A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa

et al. 2021

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Every year ~230 million adults around the world undergo major non-cardiac surgery. [1] The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study highlighted the incidence of perioperative cardiac complications in patients with cardiovascular comorbidities. The findings showed that in patients aged ≥45 years, the 30-day mortality rate was 2%, [2] and 8% had significant myocardial injury that contributed to subsequent morbidity. [3] Current guidelines emphasise the need to identify high-risk noncardiac surgical patients through preoperative risk stratification. [4] However, widely used clinical risk stratification tools such as the Revised Cardiac Risk Index (RCRI) do not perform as well as cardiovascular biomarkers, specifically natriuretic peptides (NPs). [5] Raised preoperative B-type NPs have a strong association with postoperative cardiac complications. This has been shown in observational studies and meta-analyses, and has been the impetus for including B-type NP screening for high-risk surgical patients. [6,7] Some preoperative international guidelines, such as the Canadian Cardiovascular Society (CCS) guidelines on perioperative cardiovascular risk assessment, advocate that all patients aged ≥45 years who have 'significant cardiovascular disease ' and present This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Study Strengths and Limitationsmentioning

confidence: 57%

A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa

et al. 2021

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“…NT-proBNP and BNP are well established predictive markers for adverse cardiac events after noncardiac surgery [20][21][22][23]. Guidelines on perioperative cardiac risk assessment recommended measuring preoperative NT-proBNP/BNP in patients with confirmed cardiovascular diseases or with cardiovascular risk factors to achieve better risk stratification [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have associated cardiac biomarkers B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) with risk of AKI in several medical settings [14][15][16][17][18] and in cardiac surgery [19]. Moreover, natriuretic peptides are established and guideline-recommended biomarkers for perioperative cardiovascular risk assessment in patients with elevated baseline risks undergoing non-cardiac surgery [20][21][22][23][24][25]. However, whether preoperative NT-proBNP could help to predict postoperative AKI in these patients is less clear.…”

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confidence: 99%

Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Zhao

Zhuang

Lei

et al. 2020

Preprint

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Background Acute kidney injury (AKI) is associated with poor outcomes after non-cardiac surgery. Whether preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after non-cardiac surgery is unclear. Methods We conducted a retrospective study on patients whose NT-proBNP concentrations were measured before non-cardiac surgery at a tertiary academic hospital between 2008 and 2018. Multivariable logistic regression was used to investigate the predictive role of preoperative NT-proBNP on postoperative AKI defined by the Kidney Disease: Improving Global Outcomes creatinine criteria. Results Some 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Preoperative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (odd ratio comparing top to bottom quintiles 2.29, 95% confidence interval [CI] 1.47-3.65, p<0.001 for trend; odd ratio per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI 1.16-1.39). Compared with clinical variables alone, the addition of NT-proBNP modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, p=0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI 0.111-0.308; integrated discrimination improvement 0.0044, 95% CI 0.0016-0.0072) of AKI and non-AKI cases. Conclusions Preoperative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing non-cardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

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“…The associated incidence of the primary outcome was 12.3, 20.8, and 37.5%, respectively. 16 The European Society of Cardiology (ESC) guidelines suggest biomarker measurements in high-risk patients, including NT-proBNP for prognosis assessment and cardiac troponin both before and 48-72 h after major surgery. 17,18 The most recent Universal definition of MI statement also recommends perioperative troponin surveillance for high-risk individuals undergoing noncardiac surgery.…”

Section: Which Patients Should Be Monitored For Mins?mentioning

confidence: 99%

Myocardial Injury after Noncardiac Surgery and Perioperative Atrial Fibrillation

Borges

Ofori

Marcucci

2021

Can Journ Gen Int Med

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One in 60 patients who undergo major noncardiac surgery dies within 30 days following surgery. The most common cause is cardiac complications, of which myocardial injury after noncardiac surgery (MINS) and perioperative atrial fibrillation (POAF) are common, affecting about 18 and 11% of adults, respectively, after noncardiac surgery. Patients who suffer MINS are at a higher risk of death compared to patients without MINS. Similarly, patients who develop POAF are at a higher risk of stroke and death compared to patients who do not. Most patients who suffer MINS are asymptomatic, and its diagnosis is not possible without routine troponin monitoring. Observational studies support the use of statins and aspirin in the management of patients with MINS. The only randomized controlled trial to date that has specifically addressed the management of MINS was the MANAGE trial that demonstrated the efficacy and safety of intermediate dose dabigatran in this population. There are no specific prediction models for POAF and no randomised controlled trial evidence to guide the specific management of POAF. Management guidelines in the acute period follow the management of nonoperative atrial fibrillation. The role of long-term anticoagulation in this population is still uncertain and should be guided by a shared care decision model with the patient, and with consideration of the individual risk for stroke balanced against the risk of bleeding. In this review, we present a case-based approach to the detection, prognosis, and management of MINS and POAF based on the existing evidence. RÉSUMÉUn patient sur 60 qui subit une intervention chirurgicale majeure non cardiaque meurt dans les 30 jours suivant l’opération. La cause la plus fréquente est celle des complications cardiaques, dont les lésions myocardiques après une chirurgie non cardiaque (LMCNC) et la fibrillation auriculaire périopératoire (FAPO) sont courantes et touchent respectivement environ 18 et 11 % des adultes après une chirurgie non cardiaque. Les patients présentant des LMCNC sont exposés à un risque plus élevé de décès que les patients qui ne présentent pas de LMCNC. De même, les patients chez qui on voit apparaître une FAPO ont un risque plus élevé d’accident vasculaire cérébral et de décès que ceux qui ne connaîtront pas cette complication. La plupart des patients atteints de LMCNC sont asymptomatiques, et il est impossible d’établir un diagnostic sans surveiller régulièrement la troponine. Des études d’observation appuient l’utilisation des statines et de l’aspirine dans la prise en charge des patients atteints de LMCNC. À ce jour, le seul essai contrôlé randomisé qui s’est penché précisément sur le traitement des LMCNC est l’essai MANAGE qui a démontré l’efficacité et l’innocuité du dabigatran à dose intermédiaire chez cette population. Il n’existe aucun modèle de prédiction précis pour la FAPO ni aucune donnée probante provenant d’essais contrôlés randomisés pour orienter précisément son traitement. Les lignes directrices concernant la prise en charge au cours de la période aiguë suivent celles de la prise en charge de la fibrillation auriculaire non liée à une opération. Le rôle de l’anticoagulation à long terme chez cette population est encore incertain et devrait être guidé par un modèle de prise de décision partagée avec le patient et tenir compte du risque individuel d’accident vasculaire cérébral par rapport à celui d’hémorragie. Dans cette revue, nous présentons une approche fondée sur des cas pour la détection, le pronostic et le traitement des LMCNC et de la FAPO sur la base des données probantes existantes.

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Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery

Cited by 126 publications

References 27 publications

A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa

A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa

Preoperative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after non-cardiac surgery: A retrospective cohort study

Myocardial Injury after Noncardiac Surgery and Perioperative Atrial Fibrillation

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