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Home > Vascular Annual Meeting > schouten_predictor_of_postoperative_cardiac

NT-proBNP as a Predictor of Postoperative Cardiac Events After Vascular Surgery

Olaf Schouten¹, Dustin Goei¹, Gijs J. M. Welten1, Hero van Urk¹, Jeroen J. Bax², Hence J. M. Verhagen¹, Don Poldermans.^1
1Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands;²Leiden University Medical Center, Leiden, The Netherlands.

OBJECTIVES: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is secreted by the heart and has prognostic value in patients with heart failure, coronary artery disease and heart valve abnormalities. Postoperative outcome is also related to these risk factors. This study was conducted to assess the additional prognostic value of NT-proBNP levels for postoperative cardiac events among vascular surgery patients.

METHODS: In 375 consecutive vascular surgery patients a detailed cardiac history (angina, myocardial infarction, age >70 years, diabetes, renal failure, stroke, heart failure), resting echocardiography and NT-proBNP levels were obtained. Postoperative troponin-T and ECG were obtained on day 1, 3, 7, 30 and whenever clinically indicated. Study endpoint (cardiac events) was the composite of cardiac death, myocardial infarction, and troponin release. Multivariable logistic regression analysis was used for the prognostic value of NT-proBNP, and the optimal cut-off value was assessed by ROC curve analysis.

RESULTS: Postoperative cardiac events occurred in 74 (20%) patients. Using cardiac risk factors only, patients were classified as low (0 risk factors), intermediate (1-2) and high (≥3) cardiac risk (event rate 5%, 16% and 36% respectively). The site of surgery also was an important factor in this respect (event rate 4%, 21% and 31% for carotid, lower extremity, and aortic surgery respectively). Median NT-proBNP level was 205 pg/ml (interquartile range 80-547). The risk of postoperative cardiac events was augmented with increasing NT-proBNP, irrespective of underlying cardiac risk factors and type of vascular surgery as shown in the figure. In addition to cardiac risk factors only (C-index 0.67) or cardiac risk factors and site and type of surgery (C-index 0.79), NT-proBNP was an excellent tool for further risk stratification (C-index 0.85) with an optimal cut-off value of 500 pg/ml. Adjusted for cardiac risk factors, echocardiography and site and type of surgery NT-pro-BNP>500 pg/ml remained significantly associated with cardiac events (OR 5.3, 95%CI 2.1-13.3, p=0.001).

Conclusion: NT-proBNP is an independent prognostic marker for postoperative cardiac events in patients undergoing different types of vascular surgery and might be used for preoperative cardiac risk stratification.
AUTHOR DISCLOSURES: O. Schouten, None; D. Goei, None; G.J.M. Welten, None; H. van Urk, None; J.J. Bax, None; H.J.M. Verhagen, None; D. Poldermans, None.