Exploring the Utility of Brain Natriuretic Peptide Measurement in Vascular Surgery
| Autor: | Gary K. Yang, York N. Hsiang, Sandra Strandberg, Bill Huang, Jonathan Misskey |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Revised Cardiac Risk Index Myocardial Infarction Asymptomatic Risk Assessment Predictive Value of Tests Risk Factors Internal medicine Natriuretic Peptide Brain Medicine Humans cardiovascular diseases Myocardial infarction Vascular Diseases Aged Retrospective Studies Framingham Risk Score biology business.industry General Medicine Canadian Cardiovascular Society Vascular surgery medicine.disease Brain natriuretic peptide Troponin Treatment Outcome Heart Injuries cardiovascular system Cardiology biology.protein Surgery Female medicine.symptom Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Biomarkers |
| Zdroj: | Annals of vascular surgery. 78 |
| ISSN: | 1615-5947 |
| Popis: | Background The Canadian Cardiovascular Society 2016 guidelines recommend pre-operative measurement of brain natriuretic peptide (BNP) to risk-stratify patients for a 30-day composite outcome of death, myocardial infarction, or asymptomatic myocardial injury after noncardiac surgery (MINS). Whether this practice affects outcomes is unclear. The aim of this study was to examine the clinical utility of brain natriuretic peptide and myocardial injury after noncardiac surgery. Methods Analysis of a prospectively maintained database identified all elective open vascular surgery cases at an academic teaching hospital from January 2015 to December 2018. Pre-operative BNP values were available from June 2018 onward after becoming institutionally mandated. Co-morbidities were also collected to stratify patients using the Revised Cardiac Risk Index. The composite outcome of 30-day mortality, myocardial infarction, or MINS was determined. Results Prior to BNP becoming an institutionally required test, data was available from 1176 open cases. The 30-day mortality was 1.3% (15/1176) and post-operative myocardial infarction rate was 2.3% (27/1176). BNP measurements were collected in 91 consecutive patients. Ten patients (11%) experienced the composite outcome of mortality, myocardial infarction, or MINS. Elevated BNP was associated with increased odds of the composite outcome (P = 0.04), but not with mortality or myocardial infarction. Revised Cardiac Risk Index score was not predictive of outcomes. The majority of patients who qualified for the composite outcome experienced only an asymptomatic troponin rise (80%). Two patients met the universal definition of myocardial infarction, one of whom died. No other deaths occurred within 30 days. Detection of MINS did not result in any significant changes to patient management. Conclusions Elevated BNP correlates with increased MINS. An asymptomatic troponin rise is the most commonly observed event, with unclear clinical implications. BNP may over-estimate surgical risk. Further studies on the long-term outcomes of patients with elevated BNP and MINS are required before widely adopting this strategy in vascular surgery patients. |
| Databáze: | OpenAIRE |
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