PS120. Comparison of BNP to Traditional Preoperative Risk Factors

Abstract

We evaluated the significance and value of preoperative brain natriuretic peptide (BNP) level and its relationship to postoperative cardiac complications vs traditional risk factors in patients undergoing vascular procedures. Retrospective review of prospectively collected data on 217 vascular procedures in an operating room setting from November 2006 through March 2009. Preoperative history and physical was reviewed and BNP laboratory levels obtained prior to all procedures and the postoperative course reviewed for evidence of 30-day cardiac complications. Preoperative BNP levels were obtained on all patients (Table 1). 32 patients (15%) sustained a postoperative cardiac complication consisting predominately of arrhythmias (5 patients) and myocardial infarctions (29 patients) with 4 patients ultimately requiring cardiac catheterization (12.5%). A receiver operator curve analysis demonstrated that a preoperative BNP value greater than 95.5 ρg/mL correctly identified 75% of patients with cardiac complications (AUC = 0.693). This BNP level was associated with a 3.7 times increased risk of cardiac complications. Multivariable analysis also revealed a history of ASPVD as the most significant preoperative predictor of cardiac complications followed by BNP, hypothyroidism, CAD, and prior MI (Table 2).Table 1Traditional Preoperative Risk Stratification Measures.DemographicsAge (Mean) years64.3 ± 14.9Sex Male53% Female47%Procedures AV Fistula40% EVAR18% Open AAA4% Carotid Endarterectomy22% Femoral to Popliteal Bypass6% Other8%System Based Preoperative Comorbidities Airway6% Pulmonary52% Cardiovascular96% GI/Hepatic51% Renal50% Endocrine55% Metabolic8%Preoperative Cardiac Comorbidities Hypertension96% Coronary Artery Disease34% Myocardial Infarction20% Peripheral Arterial Disease50% Dysrhythmia11% Congestive Heart Failure17% Angina7%Preoperative Comorbidities COPD28% Reactive Airway Disease5% GERD40% Chronic Renal Insufficiency59% Anemia35% Hypothyroidism8% Open table in a new tab Table 2Rank order of preoperative predictors to postoperative complications.VariableOdds Ratio (95% Confidence Interval)p valueASPVD4.44 (1.59-12.38)0.004BNP value >95.5 ρg/mL3.77 (1.6-8.8)0.002Hypothyroidism3.64 (1.17-11.33)0.026CAD3.1 (1.3-7.38)0.01Previous MI2.81 (1.13-6.94)0.026 Open table in a new tab In addition to traditional risk factors a preoperative BNP level greater than 95.5 ρg/mL is predictive of postoperative cardiac complications.