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Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery.
Heart 2007; 93(2):226-31H

Abstract

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.

Authors+Show Affiliations

Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16914484

Citation

Feringa, Harm H H., et al. "Plasma N-terminal pro-B-type Natriuretic Peptide as Long-term Prognostic Marker After Major Vascular Surgery." Heart (British Cardiac Society), vol. 93, no. 2, 2007, pp. 226-31.
Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart. 2007;93(2):226-31.
Feringa, H. H., Schouten, O., Dunkelgrun, M., Bax, J. J., Boersma, E., Elhendy, A., ... Poldermans, D. (2007). Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart (British Cardiac Society), 93(2), pp. 226-31.
Feringa HH, et al. Plasma N-terminal pro-B-type Natriuretic Peptide as Long-term Prognostic Marker After Major Vascular Surgery. Heart. 2007;93(2):226-31. PubMed PMID: 16914484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. AU - Feringa,Harm H H, AU - Schouten,Olaf, AU - Dunkelgrun,Martin, AU - Bax,Jeroen J, AU - Boersma,Eric, AU - Elhendy,Abdou, AU - de Jonge,Robert, AU - Karagiannis,Stefanos E, AU - Vidakovic,Radosav, AU - Poldermans,Don, Y1 - 2006/08/16/ PY - 2006/8/18/pubmed PY - 2007/2/6/medline PY - 2006/8/18/entrez SP - 226 EP - 31 JF - Heart (British Cardiac Society) JO - Heart VL - 93 IS - 2 N2 - 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. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/16914484/Plasma_N_terminal_pro_B_type_natriuretic_peptide_as_long_term_prognostic_marker_after_major_vascular_surgery_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=16914484 DB - PRIME DP - Unbound Medicine ER -