Assessment of Cardiac Risk Before Noncardiac Surgery: Brain Natriuretic Peptide in 1590 Patients

John M Dernellis ^1* and Maria P Panaretou ¹

¹ Vostanio Hospital, Greece

^* To whom correspondence should be addressed. E-mail: dernellis{at}yahoo.gr.

Accepted 11 May 2006

Abstract

Background Limited information exists regarding the preoperative assessment of cardiac risk in patients who, are to undergo noncardiac surgery. This study evaluated the predictive value of brain natriuretic peptide (BNP) for assessment of cardiac risk before noncardiac surgery.

Methods Consecutive patients (947 men, 643 women) who underwent BNP measurement before noncardiac surgery were studied. Clinical and electrocardiographic variables were evaluated to identify predictors of postoperative cardiac events.

Results Events occurred in 6% of patients: 21 cardiac deaths, 20 nonfatal myocardial infarctions, 41 episodes of pulmonary oedema, and 14 patients with ventricular tachycardia. All of these patients had elevated plasma levels of BNP (best cut-off point 189 pg/ml). The only independent predictor of postoperative events was BNP (p<0.0001; odds ratio 34.52, and 95% Confidence Interval: 17.08 - 68.62). Clinical variables of Goldman's multifactorial index identified 18% of patients as class I, 40% as class II, 24% as class III and 18% as class IV preoperatively; the postoperative event rates were 2%, 3%, 7% and 14%, respectively. BNP identified 60% of patients as zero risk (BNP= 0-100 pg/dl), 22% as low risk (BNP= 101-200 pg/dl), 14% as intermediate risk (BNP= 201-300 pg/dl) and 4% as high risk (BNP>300 pg/dl); postoperative event rates were 0%, 5%, 12% and 81%, respectively.

Conclusions In this population of patients evaluated before noncardiac surgery, BNP is an independent predictor of postoperative cardiac events. A BNP value greater than 189 pg/dl identified patients at highest risk.

Keywords: brain natriuretic peptide, congestive heart failure, noncardiac surgery

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