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KMID : 0338420120270030301
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The Korean Journal of Internal Medicine
2012 Volume.27 No. 3 p.301 ~ p.310
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Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Predictive of Perioperative Cardiac Events in Patients Undergoing Vascular Surgery
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Yang Ji-Hyun
Choi Jin-Ho
Ki Young-Wook
Kim Dong-Ik
Kim Duk-Kyung
Park Jeong-Rang
Oh Jae-K.
Choi Seung-Hyuk
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Abstract
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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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KEYWORD
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Pro-B-type natriuretic peptide, Vascular surgical procedures, Postoperative complications
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