Predictive value of postoperative N-terminal pro-B-type natriuretic peptide in patients suffering myocardial injury after noncardiac surgery
F K Borges, D M Gualandro, C Mueller, F Mulazzani, E Duceppe, C Puelacher, D Heels-Ansdell, A Patel, D I Sessler, M Chan, S Srinathan, R N Rodseth, B Biccard, W Szczeklik, P J DevereauxAbstract
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.