High levels of preoperative and postoperative N terminal B-type natriuretic propeptide influence mortality and cardiovascular complications after noncardiac surgery: A prospective cohort study

BACKGROUNDMajor noncardiac surgery is associated with a 5% incidence of serious cardiovascular complications and with a 1 to 2% probability of death from cardiac causes. Over the last few decades, researchers have assessed the perioperative predictive power of several risk indices. Research is currently focused on the evaluation of biomarkers.OBJECTIVESThe objective was to determine the incidence of high serum levels of N terminal B-type natriuretic propeptide (NT-proBNP) before and after surgery in adults undergoing elective major noncardiac procedures and to evaluate its relationship with mortality and cardiovascular complications occurring up to 30 days after surgery.DESIGNProspective cohort study.SETTINGEnrolment was undertaken at a university hospital from October 2011 to July 2013.PATIENTSA total of 304 adults with cardiovascular risk factors who underwent noncardiac elective surgery.MAIN OUTCOME MEASURESThe relationship between preoperative and postoperative NT-proBNP serum levels and the emergence of cardiovascular complications, including all-cause mortality, during the first 30 days after surgery.RESULTSThe incidence of cardiovascular complications was 7.8% (n=25), and the mortality rate was 4.3% (n=13). Higher-than-normal NT-proBNP serum levels were found before surgery in 48.4% (n=147) and after surgery in 50.7% (n=154) of patients. The variables found to be independent predictors of cardiovascular complications, including all-cause 30-day mortality, were levels of NT-proBNP more than 300pgml(-1) before surgery and levels more than 1000pgml(-1) both before and after surgery.CONCLUSIONHigh levels of preoperative and postoperative NT-proBNP are predictors of cardiovascular complications, including all-cause mortality, during the first 30 days after noncardiac surgery in adults with cardiovascular risk factors.