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
Por:
Karthikeyan, G, Moncur, RA, Levine, O, Heels-Ansdell, D, Chan, MTV, Alonso-Coello, P, Yusuf, S, Sessler, D, Villar, JC, Berwanger, O, McQueen, M, Mathew, A, Hill, S, Gibson, S, Berry, C, Yeh, HM, Devereaux, PJ
Publicada:
20 oct 2009
Resumen:
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%; I-2 = 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; I-2 = 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, I-2 = 51.6%), and those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I-2 = 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. (J Am Coll Cardiol 2009; 54: 1599-606) (C) 2009 by the American College of Cardiology Foundation
Filiaciones:
Karthikeyan, G:
All India Inst Med Sci, Dept Cardiol, New Delhi, India
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada
Moncur, RA:
McMaster Univ, Michael G DeGroote Sch Med, Hamilton, ON L8N 3Z5, Canada
Levine, O:
Queens Univ, Sch Med, Kingston, ON, Canada
Heels-Ansdell, D:
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
Chan, MTV:
Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R China
Alonso-Coello, P:
Hosp Santa Creu & Sant Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
CIBERESP, Barcelona, Spain
Yusuf, S:
All India Inst Med Sci, Dept Cardiol, New Delhi, India
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada
Sessler, D:
Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44106 USA
Villar, JC:
Univ Sabana, Fac Med, Bogota, Colombia
Berwanger, O:
Hosp Coracao HCor, Res Inst, IEP HCor, Sao Paulo, Brazil
McQueen, M:
McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada
Mathew, A:
Univ Western Ontario, Dept Med, London, ON, Canada
Hill, S:
McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON L8N 3Z5, Canada
Gibson, S:
Univ Glasgow, Gartnavel Gen Hosp, Dept Gen & Vasc Surg, Glasgow, Lanark, Scotland
Berry, C:
Univ Glasgow, Fac Med, BHF Glasgow Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Yeh, HM:
Natl Taiwan Univ Hosp, Dept Anesthesiol, Taipei, Taiwan
Devereaux, PJ:
McMaster Univ, Hlth Sci Ctr, Dept Med, Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada
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