Author/Authors :
Lynn E Rodseth، نويسنده , , Reitze N. and Biccard، نويسنده , , Bruce M. and Le Manach، نويسنده , , Yannick and Sessler، نويسنده , , Daniel I. and Lurati Buse، نويسنده , , Giovana A. and Thabane، نويسنده , , Lehana and Schutt، نويسنده , , Robert C. and Bolliger، نويسنده , , Daniel and Cagini، نويسنده , , Lucio and Cardinale، نويسنده , , Daniela and Chong، نويسنده , , Carol P.W. and Chu، نويسنده , , Rong and Cnotliwy، نويسنده , , Mi?os?aw and Di Somma، نويسنده , , Salvatore and Fahrner، نويسنده , , René and Lim، نويسنده , , Wen Kwang and Mahla، نويسنده , , Elisabeth and Manikandan، نويسنده , , Ramaswamy and Puma، نويسنده , , Francesco and Pyun، نويسنده , , Wook B. and Radovi?، نويسنده , , Milan and Rajagopalan، نويسنده , , Sriram and Suttie، نويسنده , , Stuart and Vanniyasingam، نويسنده , , Thuvaraha and van Gaal، نويسنده , , William J. and Waliszek، نويسنده , , Marek and Devereaux، نويسنده , , P.J.، نويسنده ,
Abstract :
Objectives
jective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (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 pre-operative NP has been measured.
ound
erative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done.
s
ducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery.
s
en eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery.
sions
onal post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.
