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 Observational Studies

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

Research output: Contribution to journalArticlepeer-review

186 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1599-1606
Number of pages8
JournalJournal of the American College of Cardiology
Volume54
Issue number17
DOIs
StatePublished - 20 Oct 2009
Externally publishedYes

Keywords

  • brain natriuretic peptide
  • perioperative myocardial infarction
  • perioperative risk

Fingerprint

Dive into the research topics of '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 Observational Studies'. Together they form a unique fingerprint.

Cite this