A Preliminary Report on the Prognostic Significance of Preoperative Brain Natriuretic Peptide and Postoperative Cardiac Troponin in Patients Undergoing Major Vascular Surgery

Bolliger, Daniel; Seeberger, Manfred D.; Buse, Giovanna Lurati; Christen, Peter; Rupinski, B. R.; Gürke, Lorenz; Filipovic, Miodrag

doi:10.1213/ane.0b013e318194f3e6

Cited by 43 publications

(47 citation statements)

References 27 publications

(21 reference statements)

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“…1). Fifty-seven studies were excluded, as we were unable to obtain sufficient data and the remaining nine studies, representing seven patient cohorts, were then eligible for analysis [2,[7][8][9][10][11][12][13][14]. An additional cohort was identified [15], resulting in eight cohorts included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

2011

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SummaryAlthough peri-operative myocardial infarction remains a significant cause of morbidity and mortality following vascular surgery, the significance of an isolated troponin leak is uncertain. This is an elevation of troponin below the diagnostic threshold for a peri-operative myocardial infarction, without symptoms or ischaemic electrocardiography changes or echocardiography signs such as new regional wall motion abnormalities. This meta-analysis aimed to determine the early (< 30 days) and intermediate (< 180 days) outcomes of vascular surgical patients with an isolated troponin leak. A full literature search up to December 2010 identified 593 studies, of which nine

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Section: Resultsmentioning

confidence: 99%

Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

2011

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“…Until recently, research was done in smaller cohorts of patients undergoing mainly vascular and other high-risk but elective surgical procedures, showing an incidence of postoperative myocardial injury of 8% to 52%. 4,12,13,[29][30][31][32][33][34][35][36][37][38][39] Studies with a follow-up time of 12 months found a 2-to 20-fold increased mortality risk. Studies including emergency surgery reported an incidence of 33% to 53% of postoperative myocardial injury and 4-to 12-fold increased mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality

et al. 2013

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Background— To identify patients at risk for postoperative myocardial injury and death, measuring cardiac troponin routinely after noncardiac surgery has been suggested. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as measured by troponin elevation, on 30-day mortality after noncardiac surgery. Methods and Results— This observational, single-center cohort study included 2232 consecutive intermediate- to high-risk noncardiac surgery patients aged ≥60 years who underwent surgery in 2011. Troponin was measured on the first 3 postoperative days. Log binomial regression analysis was used to estimate the association between postoperative myocardial injury (troponin I level >0.06 μg/L) and all-cause 30-day mortality. Myocardial injury was found in 315 of 1627 patients in whom troponin I was measured (19%). All-cause death occurred in 56 patients (3%). The relative risk of a minor increase in troponin (0.07–0.59 μg/L) was 2.4 (95% confidence interval, 1.3–4.2; P <0.01), and the relative risk of a 10- to 100-fold increase in troponin (≥0.60 μg/L) was 4.2 (95% confidence interval, 2.1–8.6; P <0.01). A myocardial infarction according to the universal definition was diagnosed in 10 patients (0.6%), of whom 1 (0.06%) had ST-segment elevation myocardial infarction. Conclusions— Postoperative myocardial injury is an independent predictor of 30-day mortality after noncardiac surgery. Implementation of postoperative troponin monitoring as standard of care is feasible and may be helpful in improving the prognosis of patients undergoing noncardiac surgery.

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“…Of the remaining studies, three reported exclusively on patients undergoing emergency surgery, 38,45,48 and one documented both elective and emergency surgeries that were classified as being high risk. 46 Certain studies investigated outcomes in a specific surgical discipline, including thoracic surgery (4), 36,50,51,54 vascular (7), 29,40,42,44,55,57,59 orthopaedic (5), 45,[47][48][49]60 major abdominal (1), 56 oesophagectomy (1), 41 while the rest documented outcomes following a variety of surgeries performed (10), 34,35,[37][38][39]43,46,52,53,58 including a mix of general, head and neck, gynaecological, orthopaedic, vascular, urological, neurosurgery and thoracic surgery.…”

Section: Included Studiesmentioning

confidence: 99%

“…All of the included studies demonstrated that an elevated preoperative NP measurement was an independent predictor of the primary study outcome. 39 was a prospective derivation study with a subsequent validation study performed; one 44 was a prospective prespecified secondary analysis of a cohort in a placebo-controlled randomised controlled trial (RCT); one 45 was a cohort extracted from a prospective observational study; and one 54 was a retrospective review of patients enrolled in a different study with prospectively collected data.…”

Section: Association Between Nps and Postoperative Major Adverse Cardmentioning

confidence: 99%

Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

Ryan

Rajah

Simmers

et al. 2015

Southern African Journal of Anaesthesia and Analgesia

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Background: A plethora of studies have shown elevated preoperative natriuretic peptide measurements to predict postoperative mortality and adverse cardiac events. Objectives: The current study aimed to demonstrate this overwhelming association and to show that further studies of this nature are unwarranted. Methods: A cumulative meta-analysis of 28 studies was conducted where the primary outcomes of mortality and adverse cardiac events were associated with elevated preoperative natriuretic peptides. Results:Cumulative meta-analysis demonstrated an odds ratio trending to a constant of 5.66, with a marked narrowing in the 95% confidence interval. Conclusions:Further studies aiming only to demonstrate an association between a preoperative natriuretic peptide threshold and the risk of postoperative adverse cardiac events are not justified. Future investigation should focus on the clinical implications of these data and the application of these findings with regard to further investigation, optimisation and appropriate adaptation of perioperative management.

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A Preliminary Report on the Prognostic Significance of Preoperative Brain Natriuretic Peptide and Postoperative Cardiac Troponin in Patients Undergoing Major Vascular Surgery

Abstract: These data suggest that measurement of preoperative BNP concentrations in addition to postoperative cTn concentrations provides additive prognostic information for MACE and mortality after major vascular surgery.

Cited by 43 publications

References 27 publications

Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality

Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

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