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

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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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