Roop Kaw, MD; Olivia Cai, MD
In patients having noncardiac surgery, is preoperative brain natriuretic peptide (BNP) blood level an independent predictor of 30-day adverse cardiovascular (CV) outcomes?
Included studies measured BNP (including N-terminal-pro-B-type natriuretic peptide [NT-proBNP]) before noncardiac surgery in patients ≥ 18 years of age. Outcome was ≥ 1 perioperative CV event (all-cause death, cardiac death, CV death, acute coronary syndrome/unstable angina, coronary artery revascularization, cardiac arrest, serious cardiac arrhythmia, heart failure, or rehospitalization for a cardiac cause) ≤ 30 days after surgery.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ACP J Club (all to Apr 2008); reference lists; personal files; and meeting abstracts (1997 to 2007) were searched for studies that reported the association between preoperative BNP level and 30–day CV events. Experts were consulted. 9 prospective cohort studies (n = 3281, mean age 57 to 74 y) met the selection criteria. 4 studies used BNP and 5 studies used NT-proBNP, with varying cutpoints to define “elevated.”
15% to 38% (mean 25%) of patients had elevated BNP. 9.6% of patients had ≥ 1 perioperative CV event. Elevated preoperative BNP or NT-proBNP levels was an independent predictor of CV outcomes at 30 days (Table). Significant heterogeneity (I2=58%, >25% considered important) across study results was not explained by type of BNP, methodological variables, or number of predictors adjusted for in analysis.
Patients with elevated preoperative brain natriuretic peptide levels are at increased risk for adverse cardiovascular outcomes within 30 days of noncardiac surgery.
Association between preoperative brain natriuretic peptide level and adverse cardiovascular events after noncardiac surgery
*CI defined in Glossary. Individual odds ratios were adjusted for other risk factors.
†Cutpoints varied across studies from 40 to 189 pg/mL for brain natriuretic peptide (3 studies) and from 201 to 533 pg/mL for N-terminal-pro-B-type natriuretic peptide (4 studies).
‡2 studies that included minor cardiovascular outcomes were excluded.
Kaw R, Cai O. Review: Preoperative brain natriuretic peptide level is an independent predictor of adverse cardiovascular events after noncardiac surgery. Ann Intern Med. ;152:JC3–12. doi: 10.7326/0003-4819-152-6-201003160-02012
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Published: Ann Intern Med. 2010;152(6):JC3-12.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Rhythm Disorders and Devices.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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