- 作者：Reitze N. Rodseth ; Bruce M. Biccard ; Yannick Le Manach ; Daniel I. Sessler ; Giovana A. Lurati Buse ; Lehana Thabane ; Robert C. Schutt ; Daniel Bolliger ; Lucio Cagini ; Daniela Cardinale ; Carol P.W. Chong ; Rong Chu ; Mi艂os艂aw Cnotliwy ; Salvatore Di Somma ; Ren茅 Fahrner ; Wen Kwang Lim ; Elisabeth Mahla ; Ramaswamy Manik ; an ; Francesco Puma ; Wook B. Pyun ; Milan Radovi膰 ; et al.
- 关键词：anesthesia ; myocardial infarction ; natriuretic peptides ; risk factors ; surgery
- 刊名：Journal of the American College of Cardiology
- 出版年：21 January, 2014
- 年：2014
- 卷：63
- 期：2
- 页码：170-180
- 全文大小：710 K
Objectives
The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured.Background
Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done.
Methods
We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and聽鈮?80 days after surgery.
Results
Eighteen eligible studies provided individual patient data (n聽= 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p聽< 0.001) and聽鈮?80 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p聽= 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p聽< 0.001) and聽鈮?80 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p聽< 0.001) after surgery.
Conclusions
Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and聽鈮?80 days after noncardiac surgery compared with a pre-operative NP measurement alone.