Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery

Yeh, Ho‐Ming; Lau, Hon-Ping; Lin, Ji-Ho; Sun, Wei‐Zen; Wang, M.-J.; Lai, Ling‐Ping

doi:10.1002/bjs.4947

Cited by 71 publications

(60 citation statements)

References 28 publications

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“…The predictive value of BNP ⁄ NT-pro-BNP for MACE following vascular surgery The results presented in this meta-analysis allow the reader to compare the performance of pre-operative BNP or NT-pro-BNP with meta-analytical data presented for Short-term studies Yeh [12] Short term (to discharge < 30 days) NT-pro-BNP 450 **** * *** Berry [13] Short term (48 h) BNP 100 **** * *** Cuthbertson [14] Short term (30 days) BNP 40 **** * *** Feringa [6] Short term (30 days) NT-pro-BNP 533 **** * *** Mahla [15] Short term (30 days) NT-pro-BNP 280 **** * *** Intermediate-term studies Cuthbertson [11] Intermediate term (180 days) BNP 35 **** * *** Feringa [7] Intermediate term (180 days) NT-pro-BNP 319 **** * *** Mahla [15] Intermediate term (180 days) NT-pro-BNP 280 **** * *** ambulatory ECG, exercise ECG, radionuclide ventriculography, myocardial perfusion scintigraphy, dypridamole stress echocardiography and dobutamine stress echocardiography in vascular surgical patients [2]. Dobutamine stress echocardiography was reported to have a sensitivity and specificity of 85% (95% CI 74-97%) and 70% (95% CI 62-79%) respectively for the prediction of 30-day MACE in vascular surgical patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…and for three of the five short-term outcome studies [12,14,15]. With the exception of one study [6], cardiac death and nonfatal MI were reported in all other shortterm studies.…”

Section: ó 2008 the Authorsmentioning

confidence: 92%

“…We identified 81 studies between 1966 and January 2008, of which five patient cohorts reported in seven studies [6,7,[11][12][13][14][15] fulfilled our inclusion criteria ( Figure 1). All the included studies were prospective, observational studies.…”

Section: Included Studiesmentioning

confidence: 99%

“…Three studies used NT-pro-BNP [6,12,15] and two studies measured plasma BNP [13,14]. All the studies reported early (< 30 day) outcomes (504 patients) and three studies [7,14,15] collected data on intermediateterm (< 180 day) outcomes (623 patients).…”

Section: Included Studiesmentioning

confidence: 99%

“…Including nonvascular surgical patients in the derivation of an optimal discriminatory threshold may alter the sensitivity and specificity of the test. Indeed an analysis of 30 day MACE of only the vascular surgical cohorts reveals a higher OR associated with an adverse outcome in the high BNP group than when the mixed cohorts [12,14] Figure 5 Pre-operative BNP and NT-pro-BNP and 30-day major adverse cardiac events. BNP meta-analysis Comparison:…”

Section: ó 2008 the Authorsmentioning

confidence: 99%

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A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

Rodseth¹,

Padayachee²,

Biccard

2008

Anaesthesia

115

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SummaryWe conducted a meta-analysis of the utility of pre-operative B-type natriuretic peptide (BNP) and N-terminal-pro B-type natriuretic peptide in predicting early (< 30 days) and intermediate (< 180 days) term mortality and major adverse cardiac events (cardiac death and nonfatal myocardial infarction) in patients following vascular surgery. A Pubmed Central and EMBASE search was conducted up to January 2008. Of 81 studies identified, seven prospective observational studies were included in the meta-analysis representing five patient cohorts: early outcomes (504 patients) and intermediate-term outcomes (623 patients). A B-type natriuretic peptide or N-terminal-pro B-type natriuretic peptide above the optimal discriminatory threshold determined by receiver operating characteristic curve analysis was associated with 30-day cardiac death (OR 7.6, 95% CI 1.33-43.4, p = 0.02), nonfatal myocardial infarction (OR 6.24, 95% CI 1.82-21.4, p = 0.004) and major adverse cardiac events (OR 17.37, 95% CI 3.31-91.15, p = 0.0007), and intermediate-term, all-cause mortality (OR 3.1, 95% CI 1.85-5.2, p < 0.0001), nonfatal myocardial infarction (OR 2.95, 95% CI 1.17-7.46, p = 0.02) and major adverse cardiac events (OR 3.31, 95% CI 2.1-5.24, p < 0.00001). B-type natriuretic peptide and N-terminal-pro B-type natriuretic peptide are potentially useful pre-operative prognostic tests in vascular surgical patients. Vascular surgery is associated with major adverse perioperative cardiac events. Unfortunately, the currently used pre-operative diagnostic tests for these patients are not statistically robust enough to accurately predict these events [1]. This was recently confirmed in a meta-analysis of six pre-operative tests for vascular surgical patients, which included: ambulatory ECG, exercise ECG, radionuclide ventriculography, myocardial perfusion scintigraphy, dipyridamole stress echocardiography and dobutamine stress echocardiography [2]. Dobutamine stress echocardiography had a trend to the best performance of the six tests for the prediction of major adverse cardiac events (defined as peri-operative cardiac death and nonfatal myocardial infarction (MI)) within 30 days of surgery [2], with a positive likelihood ratio (LR) and negative LR of 2.8 and 0.21 respectively. As statistically good discrimination requires a LR of < 0.2 and > 10, there are clearly clinical limitations to the utility of these pre-operative tests for vascular surgical patients [1].There has been recent interest in brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) as prognostic biomarkers of death and major cardiovascular events, even after control for other cardiovascular risk factors [3]. BNP is an

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Section: Discussionmentioning

confidence: 99%

“…and for three of the five short-term outcome studies [12,14,15]. With the exception of one study [6], cardiac death and nonfatal MI were reported in all other shortterm studies.…”

Section: ó 2008 the Authorsmentioning

confidence: 92%