Preoperative NT-proBNP levels >319 ng/l were associated with a 4.0-fold increased risk of all-cause mortality and a 10.9-fold increased risk of major adverse cardiac events after vascular surgery.
Cohort (n=335)
No
Effect estimate: HR 4.0 (95% CI 1.8 to 8.9)
p-value: p=<0.001
OBJECTIVE: To assess the long-term prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after major vascular surgery. DESIGN: A single-centre prospective cohort study. PATIENTS: 335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery. INTERVENTIONS: Prior to surgery, baseline NT-proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress-induced myocardial ischaemia. MAIN OUTCOME MEASURES: The prognostic value of NT-proBNP was evaluated for the endpoints all-cause mortality and major adverse cardiac events (MACE) during long-term follow-up. RESULTS: In this patient cohort (mean age: 62 years, 76% male), median NT-proBNP level was 186 ng/l (interquartile range: 65-444 ng/l). During a mean follow-up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver operating characteristic curve analysis for 6-month mortality and MACE, NT-proBNP had the greatest area under the curve compared with cardiac risk score and DSE. In addition, an NT-proBNP level of 319 ng/l was identified as the optimal cut-off value to predict 6-month mortality and MACE. After adjustment for age, cardiac risk score, DSE results and cardioprotective medication, NT-proBNP > or =319 ng/l was associated with a hazard ratio of 4.0 for all-cause mortality (95% CI: 1.8 to 8.9) and with a hazard ratio of 10.9 for MACE (95% CI: 4.1 to 27.9). CONCLUSION: Preoperative NT-proBNP level is a strong predictor of long-term mortality and major adverse cardiac events after major non-cardiac vascular surgery.
Feringa et al. (Wed,) conducted a cohort in Abdominal aortic aneurysm or lower extremity peripheral artery disease (n=335). Preoperative NT-proBNP > 319 ng/l vs. Preoperative NT-proBNP ≤ 319 ng/l was evaluated on All-cause mortality (HR 4.0, 95% CI 1.8 to 8.9, p=<0.001). Preoperative NT-proBNP levels >319 ng/l were associated with a 4.0-fold increased risk of all-cause mortality and a 10.9-fold increased risk of major adverse cardiac events after vascular surgery.