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Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients.
Coron Artery Dis 2009; 20(3):219-24CA

Abstract

OBJECTIVES

High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with the presence of coronary artery disease. The aim of this study was to assess the prognostic value of hs-CRP and NT-proBNP for postoperative cardiac events in noncardiac vascular surgery patients.

METHODS

In 592 patients, cardiac history, hs-CRP, and NT-proBNP levels were assessed preoperatively. Levels of hs-CRP of at least 6.5 mg/l and NT-proBNP of at least 350 pg/ml were defined as the optimal cut-off values for the prediction of postoperative cardiac events. The end point was the composite of 30-day cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariable regression analysis was used to evaluate the association between hs-CRP, NT-proBNP and the end point. The performance of the risk models based on cardiac risk factors alone and the addition of both biomarkers was determined using C statistics.

RESULTS

After adjustment for cardiac risk factors, site of surgery and type of procedure, elevated levels of hs-CRP (odds ratio 2.54; 95% confidence interval 1.50-4.30) and NT-proBNP (odds ratio 4.78; 95% confidence interval 2.71-8.42) remained independent predictors for postoperative cardiac events. When hs-CRP and NT-proBNP were added to the cardiac risk score, the C statistic improved from 0.79 to 0.84. A combined elevation of hs-CRP and NT-proBNP provided a seven-fold higher risk for postoperative cardiac events.

CONCLUSION

Both hs-CRP and NT-proBNP have additional value in the prediction of postoperative cardiac events in vascular surgery patients. Their integrated use improves cardiac risk stratification.

Authors+Show Affiliations

Department of Vascular Surgery, Erasmus Medical Center, 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 available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19322079

Citation

Goei, Dustin, et al. "Incremental Value of High-sensitivity C-reactive Protein and N-terminal pro-B-type Natriuretic Peptide for the Prediction of Postoperative Cardiac Events in Noncardiac Vascular Surgery Patients." Coronary Artery Disease, vol. 20, no. 3, 2009, pp. 219-24.
Goei D, Hoeks SE, Boersma E, et al. Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients. Coron Artery Dis. 2009;20(3):219-24.
Goei, D., Hoeks, S. E., Boersma, E., Winkel, T. A., Dunkelgrun, M., Flu, W. J., ... Poldermans, D. (2009). Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients. Coronary Artery Disease, 20(3), pp. 219-24. doi:10.1097/MCA.0b013e3283219e47.
Goei D, et al. Incremental Value of High-sensitivity C-reactive Protein and N-terminal pro-B-type Natriuretic Peptide for the Prediction of Postoperative Cardiac Events in Noncardiac Vascular Surgery Patients. Coron Artery Dis. 2009;20(3):219-24. PubMed PMID: 19322079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients. AU - Goei,Dustin, AU - Hoeks,Sanne E, AU - Boersma,Eric, AU - Winkel,Tamara A, AU - Dunkelgrun,Martin, AU - Flu,Willem-Jan, AU - Schouten,Olaf, AU - Bax,Jeroen J, AU - Poldermans,Don, PY - 2009/3/27/entrez PY - 2009/3/27/pubmed PY - 2009/6/6/medline SP - 219 EP - 24 JF - Coronary artery disease JO - Coron. Artery Dis. VL - 20 IS - 3 N2 - OBJECTIVES: High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with the presence of coronary artery disease. The aim of this study was to assess the prognostic value of hs-CRP and NT-proBNP for postoperative cardiac events in noncardiac vascular surgery patients. METHODS: In 592 patients, cardiac history, hs-CRP, and NT-proBNP levels were assessed preoperatively. Levels of hs-CRP of at least 6.5 mg/l and NT-proBNP of at least 350 pg/ml were defined as the optimal cut-off values for the prediction of postoperative cardiac events. The end point was the composite of 30-day cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariable regression analysis was used to evaluate the association between hs-CRP, NT-proBNP and the end point. The performance of the risk models based on cardiac risk factors alone and the addition of both biomarkers was determined using C statistics. RESULTS: After adjustment for cardiac risk factors, site of surgery and type of procedure, elevated levels of hs-CRP (odds ratio 2.54; 95% confidence interval 1.50-4.30) and NT-proBNP (odds ratio 4.78; 95% confidence interval 2.71-8.42) remained independent predictors for postoperative cardiac events. When hs-CRP and NT-proBNP were added to the cardiac risk score, the C statistic improved from 0.79 to 0.84. A combined elevation of hs-CRP and NT-proBNP provided a seven-fold higher risk for postoperative cardiac events. CONCLUSION: Both hs-CRP and NT-proBNP have additional value in the prediction of postoperative cardiac events in vascular surgery patients. Their integrated use improves cardiac risk stratification. SN - 1473-5830 UR - https://www.unboundmedicine.com/medline/citation/19322079/Incremental_value_of_high_sensitivity_C_reactive_protein_and_N_terminal_pro_B_type_natriuretic_peptide_for_the_prediction_of_postoperative_cardiac_events_in_noncardiac_vascular_surgery_patients_ L2 - http://Insights.ovid.com/pubmed?pmid=19322079 DB - PRIME DP - Unbound Medicine ER -