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Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery
  1. Harm H H Feringa1,
  2. Olaf Schouten2,
  3. Martin Dunkelgrun2,
  4. Jeroen J Bax3,
  5. Eric Boersma1,
  6. Abdou Elhendy4,
  7. Robert de Jonge5,
  8. Stefanos E Karagiannis1,
  9. Radosav Vidakovic1,
  10. Don Poldermans6
  1. 1Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Internal Medicine, Section of Cardiology, University of Nebraska, Omaha, NE, USA
  5. 5Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
  6. 6Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to:
    Dr Don Poldermans
    Erasmus MC, University of Rotterdam, Department of Anaesthesiology, Room H-921, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;d.poldermans{at}erasmusmc.nl

Abstract

Objective: To assess the long-term prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after major vascular surgery.

Design: A single-centre prospective cohort study.

Patients: 335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery.

Interventions: Prior to surgery, baseline NT-proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress-induced myocardial ischaemia.

Main outcome measures: The prognostic value of NT-proBNP was evaluated for the endpoints all-cause mortality and major adverse cardiac events (MACE) during long-term follow-up.

Results: In this patient cohort (mean age: 62 years, 76% male), median NT-proBNP level was 186 ng/l (interquartile range: 65–444 ng/l). During a mean follow-up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver operating characteristic curve analysis for 6-month mortality and MACE, NT-proBNP had the greatest area under the curve compared with cardiac risk score and DSE. In addition, an NT-proBNP level of 319 ng/l was identified as the optimal cut-off value to predict 6-month mortality and MACE. After adjustment for age, cardiac risk score, DSE results and cardioprotective medication, NT-proBNP ⩾319 ng/l was associated with a hazard ratio of 4.0 for all-cause mortality (95% CI: 1.8 to 8.9) and with a hazard ratio of 10.9 for MACE (95% CI: 4.1 to 27.9).

Conclusion: Preoperative NT-proBNP level is a strong predictor of long-term mortality and major adverse cardiac events after major non-cardiac vascular surgery.

  • AUC, area under the curve
  • CK, creatine kinase
  • DSE, dobutamine stress echocardiography
  • MACE, major adverse cardiac events
  • NT-proBNP, N-terminal pro-B-type natriuretic peptide
  • ROC, receiver operating characteristic
  • dobutamine stress echocardiography
  • natriuretic peptides
  • prognosis
  • vascular surgery

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Footnotes

  • Published Online First 16 August 2006

  • Competing interests: None.

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