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Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Predictive of Perioperative Cardiac Events in Patients Undergoing Vascular Surgery
- Source :
- The Korean Journal of Internal Medicine
- Publication Year :
- 2012
- Publisher :
- Korean Association of Internal Medicine, 2012.
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Heart Diseases
Revised Cardiac Risk Index
medicine.drug_class
Myocardial Infarction
Risk Assessment
Sensitivity and Specificity
Postoperative complications
Predictive Value of Tests
Risk Factors
Internal medicine
Natriuretic Peptide, Brain
Odds Ratio
Natriuretic peptide
Humans
Medicine
Prospective Studies
Vascular Diseases
cardiovascular diseases
Myocardial infarction
Aged
Heart Failure
Tomography, Emission-Computed, Single-Photon
Chi-Square Distribution
business.industry
Pro-B-type natriuretic peptide
Odds ratio
Perioperative
Middle Aged
Vascular surgery
medicine.disease
Peptide Fragments
Surgery
Logistic Models
Treatment Outcome
ROC Curve
Elective Surgical Procedures
Predictive value of tests
Heart failure
Multivariate Analysis
Preoperative Period
Vascular surgical procedures
Cardiology
Original Article
Female
business
Biomarkers
Subjects
Details
- ISSN :
- 20056648 and 12263303
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- The Korean Journal of Internal Medicine
- Accession number :
- edsair.doi.dedup.....b8b79171b1f3f97cc6228a810b3557bd
- Full Text :
- https://doi.org/10.3904/kjim.2012.27.3.301