Preoperative Midregional Pro-Adrenomedullin and High-Sensitivity Troponin T Predict Perioperative Cardiovascular Events in Noncardiac Surgery

Golubović, Mlađjan; Janković, Radmilo; Sokolović, Dušan; Ćosić, Vladan; Maravić-Stojković, Vera; Kostić, Tomislav; Perišić, Zoran; Lađević, Nebojša

doi:10.1159/000488197

Cited by 15 publications

(13 citation statements)

References 29 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Study Characteristics: A total of 7,877 participants were recruited in the eligible articles Among them three articles (Oscarsson et al, 2009b; Stone et al, 2014; Kopec et al, 2017) reported two biomarkers, eleven studies detected an association between BNP/ NT-proBNP and MACE (Feringa et al, 2007; Rajagopalan et al, 2008, 2011; Oscarsson et al, 2009a,b; Vetrugno et al, 2012; Cagini et al, 2014; Stone et al, 2014; Kim et al, 2016; Long et al, 2016; Kopec et al, 2017), fourteen reported an association between cTn and MACE (Lopez-Jimenez et al, 1997; Oscarsson et al, 2004, 2009b; Gibson et al, 2006; Ausset et al, 2008; Dawson-Bowling et al, 2008; Chong et al, 2009; Winkel et al, 2010; Biccard et al, 2012; Shroff et al, 2012; Gillmann et al, 2014; Kopec et al, 2017; Golubović et al, 2018; Kim et al, 2018), and four revealed a relationship between hs-CRP and MACE (Owens et al, 2007; Martins et al, 2011; Scrutinio et al, 2011; Stone et al, 2014; Table 1). The quality evaluation according to NOS of each selected article was also shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Cardiac Biomarkers Predicting MACE in Patients Undergoing Noncardiac Surgery: A Meta-Analysis

Zhang

et al. 2019

Front. Physiol.

View full text Add to dashboard Cite

Objective: The present meta-analysis was aimed to systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP), cardiac troponin (cTn), high sensitive C reactive protein (hs-CRP) and CRP for predicting postoperative major adverse cardiovascular events (MACE) in patients undergoing noncardiac surgery.Methods: A total of 26 relevant studies with 7,877 participants were collected from five databases, namely PubMed, Embase, China National Knowledge Infrastructure (CNKI), CQVIP and the Wanfang Database until August 10, 2018. And the Review Manager Version 5.3 and Stata/SE 12 software were used for data syntheses in the meta-analysis.Results: Strong relationships of BNP/NT-proBNP, cTnI/cTnT and hs-CRP with MACE were detected in patients undergoing noncardiac surgery, and the five biomarkers all increased the risk of MACE. Compared to normal levels, elevated BNP/NT-proBNP could increase the MACE risk by almost 4-fold [RR:3.92, 95%CI: 3.23–4.75, P < 0.001]; elevated BNP corresponded to a 4.5-fold risk [RR:4.57, 95%CI: 3.37–6.20, P < 0.001]; elevated NT-proBNP led to a 3-fold higher risk [RR:3.48, 95%CI: 2.71–4.46, P < 0.001]. Comparing with normal levels of cTnI/cTnT, increased cTnI/cTnT was associated with nearly 5-fold more higher risk of MACE [RR:5.52, 95%CI: 4.62–6.58, P < 0.001]; elevated cTnI faced a 5-fold risk [RR:5.21, 95%CI: 3.96–6.86, P < 0.001]; elevated cTnT resulted in nearly 6-fold higher risk [RR:5.73, 95%CI: 4.55–7.22, P < 0.001]. The elevation of hs-CRP was associated with nearly 4-fold higher risk of MACE in comparison with normal concentration [RR:3.73, 95%CI: 2.63–5.30, P < 0.001].Conclusion: According to the results of our meta-analysis, the elevations of BNP/NT-proBNP, cTnI/cTnT, and hs-CRP, pre-operation or post-operation immediately, can predict much higher risk of postoperative MACE in patients undergoing noncardiac surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Cardiac Biomarkers Predicting MACE in Patients Undergoing Noncardiac Surgery: A Meta-Analysis

Zhang

et al. 2019

Front. Physiol.

View full text Add to dashboard Cite

show abstract

“…A study that defined MACE in a similar way to our study demonstrated the low accuracy and underestimation of MACE by RCRI and another specific risk model for vascular surgery [27]. Although we were not able to demonstrate the importance of individual markers in the prediction of postoperative cardiovascular events, in a recently published study, we showed the importance of midregional proadrenomedulin as a single predictive marker measured preoperatively [28, 29]. It is difficult to create a unique way of determining the risk score in patients preparing for major vascular surgery if a large number of events are followed in the postoperative course.…”

Section: Discussionmentioning

confidence: 44%

Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery

Golubović¹,

Perić²,

Stanojević³

et al. 2018

Med Princ Pract

Self Cite

View full text Add to dashboard Cite

Objective: The aim of our study was to find the best model with sufficient power to improve the risk stratification in major vascular surgery patients during the first 30 days after this procedure. The discriminatory power of 4 biomarkers (troponin I [TnI], N-terminal prohormone of brain natriuretic peptide [NT-proBNP], creatine kinase-MB isoenzyme [CK-MB], high-sensitivity C-reactive protein [hs-CRP]) was tested as well as 2 risk assessment models and 13 different combinations of them. Subjects and Methods: The study included 122 patients (77% men, 23% women) with an average age of 67.03 ± 4.5 years. An aortobifemoral bypass was performed in 6.56% of the patients, a femoropopliteal bypass in 18.85%, and 49.18% received open surgical reconstruction of the carotid arteries. A total of 25.41% of the patients were given an aortobi-iliac bypass. Results: During the first 30 days, 13 patients (10.7%) had 17 cardiac complications. The most common complication was the new onset of atrial fibrillation (35.3%). During the first 10 days, 10 patients had 1 complication and 2 patients had 2 cardiac events, while 1 patient had 3 complications. By comparing combinations of scores and markers, it was shown that revised cardiac risk index (RCRI) + Vascular Portsmouth Physiological and Operative Severity Score (V-POSSUM) + hsTnI and RCRI + V-POSSUM + hsTnI + NT-proBNP with 100% sensitivity, > 80% specificity had the best discriminatory ability (AUC 0.924 and 0.933, respectively; p < 0.001 for both models) for cardiac complications during the 30 days after surgery. Conclusion: Combinations of traditional preoperative risk factors and scores can enhance the assessment of major adverse cardiac events (MACE) in patients preparing for large vascular surgery. Using only one risk score in these patients seems to be underperforming in preoperative risk assessment.

show abstract

“…Our previous studies regarding the correlation between preoperative values of cardiac biomarkers and postoperative cardiovascular complications (including AF) did not show significant relationship between high preoperative values of single biomarker and cardiac complications. 24 -26 In this research we showed the importance of preoperative suPAR values in predicting the occurrence of paroxysmal AF 6 months after major vascular surgery.…”

Section: Discussionmentioning

confidence: 70%

Preoperative Levels of the Soluble Urokinase-Type Plasminogen Activator Receptor as Predictor for New Episodes of Atrial Fibrillation After Vascular Surgery

Lazarević

Golubović

Milić

et al. 2021

Vasc Endovascular Surg

Self Cite

View full text Add to dashboard Cite

Introduction: The soluble urokinase-type plasminogen activator receptor (suPAR) in uPAR soluble form is produced when the uPAR is cleaved from the cell membrane during the inflammatory process. Postoperative atrial fibrillation (AF) is the most common perioperative cardiac arrhythmia. It is speculated that elevated suPAR has a role in the development of AF. The aim of our study was to investigate the predictive role of preoperative suPAR in the occurrence of AF during the first 6 months after major vascular surgery. Methods: We included 119 male and 63 female patients with an average age of 67.19 ± 6.02 years, without permanent/persistent AF. Basic predictive model (BASIC) included traditional risk factors for AF: age, gender, body mass index-BMI, smoking status, presence of arterial hypertension, diabetes mellitus and dyslipidemia. Results: Over the 6-month period, 19 (10.4%) patients had one new episode of atrial fibrillation and 2 patients (1.1%) had 2 episodes of paroxysmal atrial fibrillation. Paroxysms of AF were significantly more frequent in patients who had a resection of an abdominal aneurysm than in patients with other types of major vascular surgery. BASIC had good discriminatory ability in the prediction of AF paroxysms during the first 6 months after surgery (AUC = 0.715, 95%CI 0.590-0.840). Adding suPAR to the basic model significantly improved the discriminative ability of the predictive model for AF episodes (ΔAUC = 0.238, p < 0.001). The predictive performance of the model BASIC+CRP+suPAR, measured using AUC, NRI and IDI statistics, was very similar to the model BASIC+suPAR. Conclusion: AF is a common complication in surgical patients with high mortality and morbidity. suPAR could improve the ability of traditional risk factors to predict its occurrence up to 6 months after major vascular surgery.

show abstract

Preoperative Midregional Pro-Adrenomedullin and High-Sensitivity Troponin T Predict Perioperative Cardiovascular Events in Noncardiac Surgery

Cited by 15 publications

References 29 publications

Cardiac Biomarkers Predicting MACE in Patients Undergoing Noncardiac Surgery: A Meta-Analysis

Cardiac Biomarkers Predicting MACE in Patients Undergoing Noncardiac Surgery: A Meta-Analysis

Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery

Preoperative Levels of the Soluble Urokinase-Type Plasminogen Activator Receptor as Predictor for New Episodes of Atrial Fibrillation After Vascular Surgery

Contact Info

Product

Resources

About