| ǥ : Clinical award session
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ȣ - 490056 7 |
| NT-ProBNP predicts Perioperative Cardiac Events in Patients Undergoing Noncardiac Surgery |
| Department of Medicine, Sungkyunkwan University School of Medicine, Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea |
| Dae Kyoung Cho, Seong-Hoon Lim, Sung-Uk Kwon, Joong-Il Park, Jin-Ho Choi, Sang-Chol Lee, Young Keun On, Hyeon-Cheol Gwon, Seung Woo Park, June Soo Kim, Eun-Seok Jeon, Duk-Kyung Kim, Sang Hoon Lee, Kyung Pyo Hong, Jeong Euy Park |
Background and Objectives: Perioperative cardiac complication is a major cause of morbidity after noncardiac surgery. High-risk patients can be identified by clinical factors. We hypothesized that NT-proBNP has additional value in predicting perioperative cardiac complications. Subjects and Methods: A cohort of 451 patients referred for preoperative cardiac consultation before elective noncardiac surgery was enrolled prospectively. The level of NT-proBNP was measured within 2 weeks before surgery. Various preoperative clinical variables and laboratory results were evaluated. Perioperative cardiac event was defined by acute myocardial infarction, congestive heart failure, and primary cardiac death within 5 days after surgery. Results: Perioperative cardiac events occurred in 40 (8.9%) of 451 patients. On univariate analysis, age ≥ 70 years, vascular surgery, congestive heart failure, history of cerebrovascular accident, ischemic heart disease, atrial fibrillation on ECG, LV ejection fraction ≤ 40%, preoperative NT-proBNP ≥ 200 pg/ml, preoperative hsCRP > 0.3 mg/dl and preoperative serum creatinine > 1.3 mg/dl were significantly related to perioperative cardiac complications. In multivariate analysis, three independent predictors of perioperative cardiac events were identified: preoperative high NT-proBNP (≥ 200 pg/ml), vascular surgery and ischemic heart disease. Single measurement of preoperative NT-proBNP ≥ 200 pg/ml demonstrated high sensitivity (87.0%) and specificity (71.5%) for predicting perioperative cardiac events. Next, we compared the performance of predicting risk by the area under ROC curve. The area under ROC curve was 0.719 (95% CI, 0.623 – 0.815) for the Revised Cardiac Risk Index, 0.795 (95% CI, 0.721 – 0.869) for a preoperative NT-proBNP. When a high preoperative NT-proBNP (≥ 200 pg/ml) was combined with the Revised Cardiac Risk Index, the prediction power has significantly strengthened (area under ROC curve; 0.806 versus 0.719, p < 0.001). Conclusions: A high preoperative NT-proBNP (≥ 200 pg/ml) is a novel predictor of the perioperative cardiac complications and may have an additive role in preoperative cardiac risk index development.
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