The prognostic value of preoperative and postoperative B-type natriuretic peptides (BNP and NT proBNP) in patients having noncardiac surgery: A systematic review and individual patient data meta-analysis.

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The prognostic value of preoperative and postoperative B-type natriuretic peptides (BNP and NT proBNP) in patients having noncardiac surgery: A systematic review and individual patient data meta-analysis.

J Am Coll Cardiol. 2013 Sep 25;

Authors: Rodseth RN, Biccard BM, Le Manach Y, Sessler DI, Lurati Buse GA, Thabane L, Schutt RC, Bolliger D, Cagini L, Cardinale D, Chong CP, Chu R, Cnotliwy M, Di Somma S, Fahrner R, Lim WK, Mahla E, Manikandan R, Puma F, Pyun WB, Radović M, Rajagopalan S, Suttie S, Vanniyasingam T, van Gaal WJ, Waliszek M, Devereaux PJ

Abstract
OBJECTIVES: - To determine if measuring postoperative B-type natriuretic peptides (NP, 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 preoperative NP has been measured.
BACKGROUND: - Preoperative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated postoperative NP concentrations are independently associated with these complications. It is not clear if there is value in measuring postoperative NP when a preoperative measurement has been done.
METHODS: We conducted a systematic review and individual patient data meta-analysis to determine if the addition of postoperative NP enhanced the prediction of the composite of death and nonfatal myocardial infarction (MI) at 30 and ≥180 days after surgery.
RESULTS: 18 eligible studies provided individual patient data (n=2179). Adding postoperative NP to a risk prediction model containing preoperative NP improved model fit and risk classification at both 30 days (QICu 1280 to 1204; NRI 20%; p<0.001) and at ≥180 days (QICu 1320 to 1300; NRI 11%; p=0.003). Elevated postoperative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio [OR] 3.7; 95% CI 2.2-6.2; p<0.001) and ≥180 days (OR 2.2; 95% CI 1.9-2.7; p<0.001) after surgery.
CONCLUSIONS: Additional postoperative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal MI 30 days and ≥180 days after noncardiac surgery as compared to a preoperative NP measurement alone.a.

PMID: 24076282 [PubMed - as supplied by publisher]

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