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The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery

  • Rodseth, Reitze N. (Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa, Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio) , Pyun, Wook B. (편욱범, Division of Cardiology, Department of Internal Medicine, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea) , Devereaux, P. J. (Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada, Departments of Medicine, Clinical Epidemiology, and Biostatistics, Hamilton Health Sciences, Hamilton, Ontario, Canada) , Sessler, Daniel I. (Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio) , Buse, Giovana A. Lurati (Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland) , Thabane, Lehana (Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada, Departments of Clinical Epidemiology and Biostatistics/Anesthesia/Pediatrics, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada) , Schutt, Robert C. (Department of Internal Medicine, University of Virginia, Charlottesville, Virginia) , Bolliger, Daniel (Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland) , Cagini, Lucio (Department of Surgical Science, University of Perugia, Ospedale S. Maria, Perugia, Italy) , Cardinale, Daniela (Cardioncology Unit, European Institute of Oncology, Milan, Italy) , , , , , , , , , , , , , , , , ,
  • JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY[0735-1097], 2014, v.63 no.2, 170-180

초록/요약

Objectives The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Background Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. Methods We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and >= 180 days after surgery. Results Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and >= 180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p > 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and >= 180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. Conclusions Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and >= 180 days after noncardiac surgery compared with a pre-operative NP measurement alone. (C) 2014 by the American College of Cardiology Foundation

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