N-terminal pro-B-type Natriuretic Peptide is an Independent Predictor of All-cause Mortality and MACE after Major Vascular Surgery in Medium-term Follow-up

• Published in: European journal of vascular and endovascular surgery Vol. 41; no. 5; pp. 657 - 662
• Main Authors: Rajagopalan, S, Croal, B.L, Reeve, J, Bachoo, P, Brittenden, J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2011
• Subjects: Aged; Aged, 80 and over; All-cause mortality; Biomarkers - blood; Cause of Death - trends; Female; Follow-Up Studies; Heart Diseases - blood; Heart Diseases - etiology; Heart Diseases - mortality; Humans; Immunoenzyme Techniques; Major adverse cardiac event; Male; Medium-term outcome; Middle Aged; N-terminal pro-B-type natriuretic peptide; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prognosis; Retrospective Studies; ROC Curve; Surgery; Survival Rate - trends; Time Factors; United Kingdom - epidemiology; Vascular Diseases - blood; Vascular Diseases - mortality; Vascular Diseases - surgery; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; All-cause mortality; Medium-term outcome; N-terminal pro-B-type natriuretic peptide; Major adverse cardiac event
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2010.12.017

Abstract Objective Recent interest has focussed on the role of biomarkers to predict outcome in patients undergoing major vascular surgery. We wished to determine if pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels could predict all-cause mortality (ACM; primary aim) and major adverse cardiac event (MACE) (secondary aim) in the medium-term follow-up in patients who have undergone elective major vascular surgery. Method Patients who underwent major elective vascular surgery ( n  = 136) were followed up for up to 2 years. ACM and first MACE episode were identified from the case notes and the patient management system database of the hospital intranet. Results One patient was lost to follow-up. In the mean follow-up of 654 days, 27 (20%) died and 23 (17%) patients suffered a MACE. Receiver operator curve (ROC) analysis showed that a pre-operative NT-pro-BNP level with a cut-off of 359 pg ml−1 had a sensitivity and specificity of 73% each (area under the curve (AUC) 80%, p  < 0.001) in predicting ACM and sensitivity of 74% and specificity of 71% (AUC 75%, p  < 0.001) to detect a MACE. The overall 2-year survival rate was 84%, 93% in the <359 pg ml−1 group and 68% in the ≥359 pg ml−1 group ( p  < 0.001). Following multivariate analysis, pre-operative NT-pro-BNP at a value of ≥359 pg ml−1 remained an independent predictor of ACM (odds ratio 3.6 (confidence interval (CI): 1.6–8.1), p  = 0.002) Postoperative NT-pro-BNP was a predictor of mortality but not a MACE. Conclusion This study has shown that pre-operative NT-pro-BNP is an independent predictor of ACM and MACE on medium-term follow-up.