Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery

Harm H H Feringa, Olaf Schouten, Martin Dunkelgrun, Jeroen J Bax, Eric Boersma, Abdou Elhendy, Robert de Jonge, Stefanos E Karagiannis, Radosav Vidakovic, Don Poldermans
Heart 2007, 93 (2): 226-31

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 > or =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.

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