Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro–B-Type Natriuretic Peptide Measurement an Independent Predictor of Adverse Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery?: A Systematic Review and Meta-Analysis of Obser

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• 作者：Ganesan Karthikeyan ; Ross A. Moncur ; Oren Levine ; Diane Heels-Ansdell ; Matthew T.V. Chan ; Pablo Alonso-Coello ; Salim Yusuf ; Daniel Sessler ; Juan Carlos Villar ; Otavio Berwanger ; Matthew McQueen ; Anna Mathew ; Stephen Hill ; Simon Gibson ; Colin Berry ; Huei-Ming Yeh ; P.J. Devereaux
• 关键词：perioperative myocardial infarction ; brain natriuretic peptide ; perioperative risk
• 刊名：Journal of the American College of Cardiology
• 出版年：2009
• 出版时间：20 October 2009
• 年：2009
• 卷：54
• 期：17
• 页码：1599-1606
• 全文大小：588 K

文摘

Objectives

We conducted a systematic review and meta-analysis to determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or N-terminal pro–B-type natriuretic peptide [NT-proBNP]) is an independent predictor of 30-day adverse cardiovascular outcomes after noncardiac surgery.

Background

Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting.

Methods

We employed 5 search strategies (e.g., searching bibliographic databases), and we included all studies that assessed the independent prognostic value of pre-operative BNP measurement as a predictor of cardiovascular complications after noncardiac surgery. We determined study eligibility and conducted data abstraction independently and in duplicate. We calculated a pooled odds ratio using a random effects model.

Results

Nine studies met eligibility criteria, and included a total of 3,281 patients, among whom 314 experienced 1 or more perioperative cardiovascular complications. The average proportion of patients with elevated BNP was 24.8 % (95 % confidence interval [CI]: 20.1 to 30.4 % ; I² = 89 % ). All studies showed a statistically significant association between an elevated pre-operative BNP level and various cardiovascular outcomes (e.g., a composite of cardiac death and nonfatal myocardial infarction; atrial fibrillation). Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95 % CI: 8.5 to 43.7; I² = 58 % ). The pre-operative BNP measurement was an independent predictor of perioperative cardiovascular events among studies that only considered the outcomes of death, cardiovascular death, or myocardial infarction (OR: 44.2, 95 % CI: 7.6 to 257.0, I² = 51.6 % ), and those that included other outcomes (OR: 14.7, 95 % CI: 5.7 to 38.2, I² = 62.2 % ); the p value for interaction was 0.28.

Conclusions

These results suggest that an elevated pre-operative BNP or NT-proBNP measurement is a powerful, independent predictor of cardiovascular events in the first 30 days after noncardiac surgery.