NT-proBNP incorporated in prediction rule of major peri-operative adverse cardiac event in non-cardiac surgery

Patients undergoing non-cardiac surgery are at risk for peri-operative major cardiac events (PMCEs). The most common risk assessment tool is Revised Cardiac Risk Index (RCRI). N-terminal pro-brain natriuretic peptide (NT-proBNP) measured peri-operatively has prognostic information but the implicatio...

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Veröffentlicht in:The surgeon (Edinburgh) 2019-06, Vol.17 (3), p.127-132
Hauptverfasser: Binh, Truong Quang, Trang, Do Van, Vuong, Nguyen Lam, Khoi, Nguyen Van, Elfaituri, Muhammed Khaled, Huu Loc, Tran Thai, Kamel, Mohamed Gomaa, Minh, Le Huu Nhat, Huy, Nguyen Tien
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Sprache:eng
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Zusammenfassung:Patients undergoing non-cardiac surgery are at risk for peri-operative major cardiac events (PMCEs). The most common risk assessment tool is Revised Cardiac Risk Index (RCRI). N-terminal pro-brain natriuretic peptide (NT-proBNP) measured peri-operatively has prognostic information but the implication is uncertain. This study aimed to determine the accuracy of combining NT-proBNP and RCRI in predicting the PMCE in major non-cardiac surgery. We performed a prospective cohort study to include non-cardiac surgical patients with moderate or high risk. PMCE included myocardial infarction, pulmonary edema, severe cardiac arrhythmias, and cardiac death occurring within 30 days post-operatively. Logistic regression models and the receiver operating characteristic (ROC) curves were used to determine the discriminative ability of NT-proBNP alone or incorporation with RCRI or its components in predicting PMCE. A total of 366 patients was included in the study with 48 PMCEs. When predicting PMCE, the area under the ROC curve (AUC) (95%-CI) of NT-proBNP alone and NT-proBNP incorporated with RCRI were 0.875 (0.819–0.932) and 0.882 (0.827–0.937), respectively. When incorporating NT-proBNP with the RCRI's components, the best four chosen models had the AUCs between 0.879 and 0.891. All these AUCs were not significantly different with the AUC of NT-proBNP alone. Higher preoperative NT-proBNP level leads to the increased risk of PMCE in patients undergoing non-cardiac surgery. Compared to NT-proBNP alone, the combination of NT-proBNP with the RCRI and other factors does not improve the accuracy in predicting PMCE. Future large studies are required to build a more accurate risk score.
ISSN:1479-666X
2405-5840
DOI:10.1016/j.surge.2019.03.002