The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Rodseth, Reitze; Buse, Giovanna Lurati; Bolliger, Daniel; Burkhart, Christoph; Cuthbertson, Brian H.; Gibson, Simon C.; Mahla, Elisabeth; Leibowitz, David; Biccard, Bruce

doi:10.1016/j.jacc.2011.04.018

Cited by 138 publications

(86 citation statements)

References 39 publications

(53 reference statements)

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“…Presently, almost a quarter century after the first patients were entered in the model, use of the RCRI is now widespread. [8][9][10][11] In this interval, the diagnostic criteria for myocardial infarction have changed, 12 and we are unaware of any studies that have re-examined the two factors, diabetes and chronic renal failure. As a result, we submit there is a need to re-examine the accuracy and clinical utility of the index.…”

Section: Résumémentioning

confidence: 99%

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

101

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The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients L'indice de risque cardiaque modifié dans le nouveau millénaire: une réévaluation prospective et unicentrique de cohorte des variables originales chez 9519 patients consécutifs devant subir une chirurgie non urgente Abstract Purpose Cardiac complications following non-cardiac surgery are major causes of morbidity and mortality. The Revised Cardiac Risk Index (RCRI) has become a standard for predicting post-surgical cardiac complications. This study re-examined the original six risk factors to confirm their validity in a large modern prospective database.Methods Using the definitions in the original risk index, this study included 9,519 patients aged C 50 undergoing elective non-cardiac surgery with an expected length of stay C two days at two major tertiary-care teaching hospitals. The validity of the original predictors was tested in this population using binomial logistic regression modelling, area under the receiver operator curve (ROC) analysis, and the net reclassification index. Results Rates of major cardiac complications with 0, 1, 2, C 3 of the predictors were 0.5%, 2.6%, 7.2%, and 14.4%, respectively, in our patient cohort compared with 0.4%, 1.1%, 4.6%, and 9.7%, respectively, in the original cohort. Similar to the original report, binary logistic regression analysis showed that both preoperative treatment with insulin (odds ratio [OR] 1.4; 95% confidence interval [CI] 0.7 to 2.6) and preoperative creatinine [ 176.8 mmolÁL -1 (OR 1.7; 95% CI 0.8 to 3.6) did not improve the predictive ability of the index. Analysis of the remaining four factors resulted in an area under the curve (AUC) identical to that seen for the reconstructed six-factor RCRI (AUC = 0.79). We found that a Author contributions Christopher Davis organized and performed the analysis, wrote the first draft of the manuscript, and was responsible for major revisions to both the analysis and manuscript. Gordon Tait was responsible for creation of the database and the data integrity. He performed and or supervised quality checks on the data and helped perform the data analysis. Gordon Tait, Jo Carroll, and Duminda N. Wijeysundera made key revisions to the manuscript. Jo Carroll assisted in the creation of the database and quality control of the data. Duminda N. Wijeysundera and W. Scott Beattie were responsible in part for the concept of the study. Duminda N. Wijeysundera revised key aspects of the data analysis. W. Scott Beattie was responsible in part for supervision of the project. He obtained funding for the project, helped write all drafts of the manuscript, and made revisions to the data analysis. Dr. Beattie was Mr. Davis's summer elective supervisor. All authors have seen the data analysis and the revised manuscript and vouch for the authenticity of all aspects of this manuscript. glomerular filtration rate (GFR) \ 30 mLÁmin -1 was a better predictor of major...

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Section: Résumémentioning

confidence: 99%

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

101

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“…Хотя рутинное использо-вание КАГ показало свое преимущество в ряде прове-денных исследований [6,7,9,10], по-видимому, будут продолжены попытки разработать оптимальную батарею неинвазивных тестов, способных выявить больных с наиболее вероятным поражением коро-нарных артерий [13]. Это может быть оценка степени дилатации сердца при стресс-ЭхоКГ [8], оценка каль-циевого индекса, таких биомаркеров, как мозговой натрий-уретический пептид [14], С-реактинвый белок [15], проведение МСКТ-ангиографии коро-нарных артерий. При этом необходимо будет учиты-вать не только медицинские показания, но и эконо-мическую эффективность.…”

Section: Discussionunclassified

Potential of coronary angiography in the assessment of cardiac complication risk during non-cardiac interventions

Sumin¹,

Безденежных²,

Evdokimov³

et al. 2013

Russ J Cardiol

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“…There are several meta-analyses and systematic reviews of studies evaluating BNPs in the surgical population; and they consistently demonstrate that BNPs, in particular when drawn preoperation compared with postoperation, are independent predictors of both short-and long-term adverse cardiac events, including cardiac deaths and all-cause mortality [143,144]. In addition, BNPs were found to be useful as a stratification tool to assess risk for postoperative cardiovascular complications [145]. A meta-analysis of vascular surgery patients found that increased preoperative BNP levels (including NT-proBNP) were associated with increased risk of 30-day postoperative cardiac events, cardiac-related mortality and all-cause deaths up to 180 days [144].…”

Section: Brain Natriuretic Peptides As a Marker Of Cardiovascular Rismentioning

confidence: 96%

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

et al. 2016

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Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity.

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The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Abstract: Pre-operative NP levels can be used to independently predict cardiovascular events in the first 30 days after vascular surgery and to significantly improve the predictive performance of the revised cardiac risk index.

Cited by 138 publications

References 39 publications

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Potential of coronary angiography in the assessment of cardiac complication risk during non-cardiac interventions

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

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