Preoperative NT-proBNP strongly predicts cardiovascular events after noncardiac surgery

Preoperative N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a robust predictor of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after the procedure, reveals a study. Consequently, adding NT-proBNP thresholds to the Revised Cardiac Risk Index (RCRI) improves cardiac prediction.

Multivariable analyses revealed significantly increased risks of the composite of vascular death and MINS within 30 days of surgery with preoperative NT-proBNP values of 100 to <200 pg/mL (adjusted hazard ratios [aHR], 2.27, 95 percent confidence interval [CI], 1.90–2.70), 200 to <1,500 pg/mL (aHR, 3.63, 95 percent CI, 3.13–4.21) and ≥1,500 pg/mL (aHR, 5.82, 95 percent CI, 4.81–7.05) as compared to <100 pg/mL (reference group).

The corresponding incidences of this outcome were 12.3 percent (226 of 1,843), 20.8 percent (542 of 2,608) and 37.5 percent (223 of 595).

The addition of NT-proBNP thresholds to clinical stratification (ie, RCRI) also led to a net absolute reclassification improvement of 258 per 1,000 patients. Moreover, a statistically significant association was observed between preoperative NT-proBNP values and 30-day all-cause mortality (incidence: <100 pg/mL, 0.3 percent; 100 to <200 pg/mL, 0.7 percent; 200 to <1,500 pg/mL, 1.4 percent; ≥1,500 pg/mL, 4.0 percent).

This prospective cohort study was conducted in 16 hospitals across nine countries and included 10,402 patients aged ≥45 years who underwent inpatient noncardiac surgery. NT-proBNP levels in all patients were measured before surgery. Troponin T levels were also measured daily for up to 3 days postsurgery.

“External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings,” the investigators said.