RT Journal Article
SR Electronic
T1 Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 226
OP 231
DO 10.1136/hrt.2006.093716
VO 93
IS 2
A1 Harm H H Feringa
A1 Olaf Schouten
A1 Martin Dunkelgrun
A1 Jeroen J Bax
A1 Eric Boersma
A1 Abdou Elhendy
A1 Robert de Jonge
A1 Stefanos E Karagiannis
A1 Radosav Vidakovic
A1 Don Poldermans
YR 2007
UL http://heart.bmj.com/content/93/2/226.abstract
AB 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.