Key result
Elevated postoperative NT-proBNP in MINS is linked to ~2.9-fold higher 30-day mortality and MACE.
Why the study?
Patients with myocardial injury after noncardiac surgery (MINS) have variable outcomes and require enhanced risk stratification. Whether postoperative NT-proBNP improves prediction of 30-day death and MACE among patients with MINS was evaluated.
Does a postoperative NT-proBNP concentration ≥718 pg/ml predict 30-day all-cause mortality and major adverse cardiovascular events in patients with myocardial injury after noncardiac surgery?
Cohort (n=179)
Does a postoperative NT-proBNP concentration ≥718 pg/ml predict 30-day all-cause mortality and major adverse cardiovascular events in patients with myocardial injury after noncardiac surgery?
In patients with myocardial injury after noncardiac surgery, postoperative NT-proBNP levels ≥718 pg/ml independently predict a nearly three- to four-fold increased risk of 30-day death and major adverse cardiovascular events, aiding in short-term risk stratification.
Answers are grounded in this paper and cite their sources.
Postoperative NT-proBNP ≥718 pg/ml was associated with higher 30-day risk in MINS; hypothesis-generating for risk stratification, pending prospective trials.
Background Cardiovascular complications are the leading cause of death within 30 days after noncardiac surgery. Myocardial injury after noncardiac surgery (MINS) is the most common cardiovascular complication and is independently associated with increased 30-day mortality. Although MINS portends a poor prognosis, patients with MINS have variable outcomes and there is a need for enhanced risk stratification. Purpose We aimed to assess if postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) improved predicting of death and major adverse cardiovascular events (MACE) within 30 days among patients with MINS. Methods We conducted a sub-analysis in the VISION Biobank cohort study, restricted to patients who had developed MINS and had a postoperative NT-proBNP assessment on the day of or after the MINS event. We validated the results within the BASEL-PMI study cohort. We hypothesized that a predefined threshold of postoperative NT-proBNP concentrations ≥718 pg/ml predicted a worse outcome. The primary outcome was a composite of all-cause mortality and MACE (myocardial infarction on postoperative day 4 or later, acute heart failure, non-fatal cardiac arrest, and cardiac revascularization) at 30-days after surgery. Adjusted cox proportional hazard models were built. Results Among 179 patients with MINS, median age 72.7 years, 36.9% women, the primary outcome occurred in 22 (12%) patients. Patients with postoperative NT-proBNP ≥718 pg/ml exhibited a 30-day outcome rate of 17% (16/93 patients) compared to 7% (6/86 patients) of those with values <718 pg/ml (adjusted Hazard Ratio [aHR] 2.9, 95% confidence interval [CI] 1.1-7.6, p=0.026). The validation cohort with 382 patients with MINS, confirmed these findings (30-day aHR 4.2; 95% CI 1.7-10.4, p=0.002). Conclusion In patients with MINS, postoperative NT-proBNP concentrations are predictors of death and MACE and can help in guiding short-term cardiac risk assessment, medical management, and follow-up for patients with MINS.
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Borges et al. (2026) conducted a cohort in Myocardial injury after noncardiac surgery (MINS) (n=179). Postoperative NT-proBNP ≥718 pg/ml vs. Postoperative NT-proBNP <718 pg/ml was evaluated on Composite of all-cause mortality and MACE (myocardial infarction on postoperative day 4 or later, acute heart failure, non-fatal cardiac arrest, and cardiac revascularization) at 30 days after surgery (aHR 2.9, 95% CI 1.1-7.6, p=0.026). Postoperative NT-proBNP ≥718 pg/ml predicted higher 30-day all-cause death and MACE in MINS patients compared to <718 pg/ml (17% vs 7%; aHR 2.9; 95% CI 1.1-7.6; p=0.026).
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