Prediction of perioperative cardiac events through preoperative NT-pro-BNP and cTnI after emergent non-cardiac surgery in elderly patients.

Jinling Ma,Yutang Wang,Jie Liu,Xiujie Wang,Meng Gao,Qian Xin,Simon Body

doi:10.1371/journal.pone.0121306

Jinling Ma, Yutang Wang + Show 5 more

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https://doi.org/10.1371/journal.pone.0121306

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Abstract

ObjectivesClinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery. The aim of this study was to determine whether the combined measurement of pre-operative N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) could provide useful prognostic information about postoperative major adverse cardiac events (MACE) within 30 days in patients aged over 60 years undergoing emergent non-cardiac surgery.MethodsThe study group comprised 2519 patients aged over 60 years that were undergoing emergent non-cardiac surgery between December 2007 and December 2013. NT-pro-BNP and cTnI were measured during hospital admission. The patients were monitored for MACE (cardiac death, non-fatal myocardial infarction, or cardiac arrest) during the 30-day postoperative follow-up period.ResultsMACE occurred in 251 patients (10.0%). Preoperative NT-pro-BNP and cTNI level were significantly higher in the individuals that experienced MACE than in those who did not (P < 0.001). The confounding factors of age, sex, co-morbidities and preoperative medications were adjusted in a multivariate logistic regression analysis. This analysis showed that preoperative NT-proBNP level > 917 pg/mL (OR 4.81, 95% CI 3.446–6.722, P < 0.001) and cTnI ≥ 0.07 ng/mL (OR 8.74, 95% CI 5.881–12.987, P < 0.001) remained significantly and independently associated with MACE after the adjustment of the confounding factors. Kaplan-Meier event-free survival curves demonstrated that patients with preoperative simultaneous NT-proBNP level > 917 pg/mL and cTnT ≥0.07 ng/mL had worse event-free survival than individual assessments of either biomarker.ConclusionPreoperative plasma NT-proBNP and cTnI are both independently associated with an increased risk of MACE in elderly patients after emergent non-cardiac surgery. The combination of these biomarkers provides better prognostic information than using either biomarker separately.

Highlights

Clinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery [1]
Preoperative NT-pro-BNP and cTNI level were significantly higher in the individuals that experienced major adverse cardiac events (MACE) than in those who did not (P < 0.001)
This analysis showed that preoperative NT-proBNP level > 917 pg/mL and cardiac troponin I (cTnI) 0.07 NT-pro-BNP (pg/mL) Preoperative cTNI (ng/mL) remained significantly and independently associated with MACE after the adjustment of the confounding factors

Summary

Introduction

Clinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery [1]. Emergency surgery patients often have limited preoperative physical activity that can provide accurate assessment of cardiac risk [2]. The guidelines of the European Society of Cardiology and the European Society of Anesthesiology for preoperative cardiac risk assessment have recommended the consideration of preoperative NT-pro-BNP measurement in high-risk non-cardiac surgery patients [14]. The availability of powerful cardiovascular biomarkers, such as troponins and NT-pro-BNP, offer the opportunity for further refinement of clinical scores [17]

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