The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery
| Autor: | Daniel Bolliger, Giovana A. Lurati Buse, René Fahrner, Daniela Cardinale, Philip J. Devereaux, Sriram Rajagopalan, Salvatore Di Somma, Reitze N. Rodseth, Thuvaraha Vanniyasingam, Wen Kwang Lim, Rong Chu, Wook Bum Pyun, Francesco Puma, Lehana Thabane, Daniel I. Sessler, Carol P Chong, William J. van Gaal, Lucio Cagini, Ramaswamy Manikandan, Milan Radovic, Elisabeth Mahla, Miłosław Cnotliwy, Stuart Suttie, Yannick Le Manach, Robert C. Schutt, Marek Waliszek, Bruce M Biccard |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
biology business.industry medicine.drug_class Revised Cardiac Risk Index Odds ratio Perioperative 030204 cardiovascular system & hematology Brain natriuretic peptide medicine.disease Troponin 3. Good health Surgery 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Interquartile range Internal medicine biology.protein medicine Natriuretic peptide Cardiology Myocardial infarction business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 63(2):170-180 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2013.08.1630 |
| Popis: | Objectives The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Background Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. Methods We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. Results Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p Conclusions Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone. |
| Databáze: | OpenAIRE |
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