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Biomarkers and heart disease
Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery
  1. J-H Choi1,2,
  2. D K Cho3,
  3. Y-B Song1,
  4. J-Y Hahn1,
  5. S Choi1,
  6. H-C Gwon1,
  7. D-K Kim1,
  8. S H Lee1,
  9. J K Oh1,4,
  10. E-S Jeon1
  1. 1
    Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. 2
    Department of Emergency Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  3. 3
    Department of Cardiology, Hanmaeum General Hospital, Jeju, Korea
  4. 4
    Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Eun-Seok Jeon, Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-ku, Seoul, Korea, 135-710; esjeon{at}skku.edu

Abstract

Objective: To investigate whether simple and non-invasive measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and/or C-reactive protein (CRP) can predict perioperative major cardiovascular event (PMCE).

Design: Prospective, single-centre, cohort study.

Setting: A 1900-bed tertiary-care university hospital in Seoul, Korea

Design and patients: The predictive power of NT-proBNP, CRP and Revised Cardiac Risk Index (RCRI) for the risk of PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) were evaluated from a prospective cohort of 2054 elective major non-cardiac surgery patients. Optimal cut-off values were derived from receiver operating characteristic curve (ROC) analysis.

Main outcome measurement: PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) within postoperative 30 days.

Results: PMCE developed in a total of 290 patients (14.1%). Each increasing quartile of NT-proBNP or CRP level was associated with a greater risk of PMCE after adjustment for traditional clinical risk factors. The relative risk (RR) of highest versus lowest quartile was 5.2 for NT-proBNP (p<0.001) and 3.7 for CRP (p<0.001). Both NT-proBNP (cut-off  = 301 ng/l) and CRP (cut-off  = 3.4 mg/l) predicted PMCE better than RCRI (cut-off  = 2) by ROC analysis (p<0.001). Moreover, the predictive power of RCRI (adjusted RR  = 1.5) could be improved significantly by addition of CRP and NT-proBNP to RCRI (adjusted RR 4.6) (p<0.001).

Conclusions: High preoperative NT-proBNP or CRP is a strong and independent predictor of perioperative major cardiovascular event in non-cardiac surgery. The predictive power of current clinical risk evaluation system would be strengthened by these biomarkers.

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Footnotes

  • Funding This study was supported by grants from the Samsung Medical Center Clinical Research Development Program and the In-Sung Foundation for Medical Research, Seoul, Korea.

  • Competing interests None declared.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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