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Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery.
Am J Cardiol 2010; 106(6):865-72AJ

Abstract

After emergency orthopedic-geriatric surgery, cardiac complications are an important cause of morbidity and mortality. The utility of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for the prediction of cardiac complications and mortality was evaluated. NT-pro-BNP was tested pre- and postoperatively in 89 patients >60 years of age. They were followed for 2 years for cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) or death. Receiver operating characteristic curves were constructed to determine the optimal discriminatory level for cardiac events and death using NT-pro-BNP. Twenty-three patients (25.8%) sustained an in-hospital postoperative cardiac complication. Total all-cause mortality was 3 of 89 (3.4%) in hospital, 21 of 89 (23.6%) at 1 year, and 27 of 89 (30.3%) at 2 years. Median preoperative and postoperative NT-pro-BNP levels were higher in patients who had an in-hospital cardiac event compared to those without (387 vs 1,969 pg/ml, p <0.001; and 676 vs 7,052 pg/ml, p <0.001 respectively). The optimal discriminatory level for preoperative NT-pro-BNP was 842 pg/ml and that for postoperative NT-pro-BNP was 1,401 pg/ml for the prediction of in-hospital cardiac events and 1- and 2-year mortality. Preoperative NT-pro-BNP >/=842 pg/ml (odds ratio 11.6, 95% confidence interval 2.1 to 65.0, p = 0.005) was an independent predictor of in-hospital cardiac complications using multivariate analysis and pre- and postoperative NT-pro-BNP levels were independent predictors of 2-year cardiovascular events. Patients who had preoperative NT-pro-BNP >/=842 pg/ml or postoperative NT-pro-BNP >/=1,401 pg/ml had significantly worse survival using log-rank testing (p <0.001) and these variables independently predicted 2-year mortality. In conclusion, increase pre- and postoperative NT-pro-BNP levels are independent predictors of in-hospital cardiac events and 1- and 2-year mortality in older patients undergoing emergency orthopedic surgery.

Authors+Show Affiliations

Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.auNo 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

20816130

Citation

Chong, Carol P., et al. "Usefulness of N-terminal Pro-brain Natriuretic Peptide to Predict Postoperative Cardiac Complications and Long-term Mortality After Emergency Lower Limb Orthopedic Surgery." The American Journal of Cardiology, vol. 106, no. 6, 2010, pp. 865-72.
Chong CP, Ryan JE, van Gaal WJ, et al. Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery. Am J Cardiol. 2010;106(6):865-72.
Chong, C. P., Ryan, J. E., van Gaal, W. J., Lam, Q. T., Sinnappu, R. N., Burrell, L. M., ... Lim, W. K. (2010). Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery. The American Journal of Cardiology, 106(6), pp. 865-72. doi:10.1016/j.amjcard.2010.05.012.
Chong CP, et al. Usefulness of N-terminal Pro-brain Natriuretic Peptide to Predict Postoperative Cardiac Complications and Long-term Mortality After Emergency Lower Limb Orthopedic Surgery. Am J Cardiol. 2010 Sep 15;106(6):865-72. PubMed PMID: 20816130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery. AU - Chong,Carol P, AU - Ryan,Julie E, AU - van Gaal,William J, AU - Lam,Que T, AU - Sinnappu,Rabindra N, AU - Burrell,Louise M, AU - Savige,Judy, AU - Lim,Wen Kwang, PY - 2010/02/12/received PY - 2010/05/11/revised PY - 2010/05/11/accepted PY - 2010/9/7/entrez PY - 2010/9/8/pubmed PY - 2010/9/30/medline SP - 865 EP - 72 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 106 IS - 6 N2 - After emergency orthopedic-geriatric surgery, cardiac complications are an important cause of morbidity and mortality. The utility of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for the prediction of cardiac complications and mortality was evaluated. NT-pro-BNP was tested pre- and postoperatively in 89 patients >60 years of age. They were followed for 2 years for cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) or death. Receiver operating characteristic curves were constructed to determine the optimal discriminatory level for cardiac events and death using NT-pro-BNP. Twenty-three patients (25.8%) sustained an in-hospital postoperative cardiac complication. Total all-cause mortality was 3 of 89 (3.4%) in hospital, 21 of 89 (23.6%) at 1 year, and 27 of 89 (30.3%) at 2 years. Median preoperative and postoperative NT-pro-BNP levels were higher in patients who had an in-hospital cardiac event compared to those without (387 vs 1,969 pg/ml, p <0.001; and 676 vs 7,052 pg/ml, p <0.001 respectively). The optimal discriminatory level for preoperative NT-pro-BNP was 842 pg/ml and that for postoperative NT-pro-BNP was 1,401 pg/ml for the prediction of in-hospital cardiac events and 1- and 2-year mortality. Preoperative NT-pro-BNP >/=842 pg/ml (odds ratio 11.6, 95% confidence interval 2.1 to 65.0, p = 0.005) was an independent predictor of in-hospital cardiac complications using multivariate analysis and pre- and postoperative NT-pro-BNP levels were independent predictors of 2-year cardiovascular events. Patients who had preoperative NT-pro-BNP >/=842 pg/ml or postoperative NT-pro-BNP >/=1,401 pg/ml had significantly worse survival using log-rank testing (p <0.001) and these variables independently predicted 2-year mortality. In conclusion, increase pre- and postoperative NT-pro-BNP levels are independent predictors of in-hospital cardiac events and 1- and 2-year mortality in older patients undergoing emergency orthopedic surgery. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/20816130/Usefulness_of_N_terminal_pro_brain_natriuretic_peptide_to_predict_postoperative_cardiac_complications_and_long_term_mortality_after_emergency_lower_limb_orthopedic_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(10)01051-9 DB - PRIME DP - Unbound Medicine ER -