NT-proBNP or Self-Reported Functional Capacity in Estimating Risk of Cardiovascular Events After Noncardiac Surgery
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Published:2023-11-08
Issue:11
Volume:6
Page:e2342527
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Lurati Buse Giovanna1, Larmann Jan2, Gillmann Hans-Jörg3, Kotfis Katarzyna4, Ganter Michael T.5, Bolliger Daniel6, Filipovic Miodrag7, Guzzetti Luca8, Chammartin Frédérique9, Mauermann Eckhard10, Ionescu Daniela11, Szczeklik Wojciech12, De Hert Stefan13, Beck-Schimmer Beatrice14, Howell Simon J.15, Kemper Johann16, Kohaupt Lena16, Witzler Jette16, Tuzhikov Michael16, Roth Sebastian16, Stroda Alexandra16, MPembele Rene16, Schultze Cornelia16, Verbarg Nele16, Gehrke Christian16, Espeter Florian16, Russe Benedikt16, Weigand Markus A.16, Pirzer Raphael16, Rach Patric Rene16, Neumann Claudia16, Sponhol Christoph16, Carollo Melissa16, Toso Fiorenza16, Bacuzzi Alessandro16, Servén Marta G.16, Artigas Soler Anna16, Basso Morena16, Peig Font Anna16, Torrente-Perez Jara16, Fores Maria Isabel16, Bubenek-Turconi Serban16, Vale Liana16, Wanner Patrick16, Djurdjevic Mirjana16, Nuth Sandra16, Seeberger Esther16, Kamber Firmin16, Gerber Thomas Jan16, Schneebeli Daniela16, Grape Sina16, Bollen Pinto Bernardo16, Karolak Igor16, Lechowicz Kacper16, Drozdzal Sylwester16, Kluzik Anna16, van Lier Felix16, Carrao Andre16, Ribeiro Daniela16, Santos Nuno16, Drummond Andrew16, Belskii Vladislav16,
Affiliation:
1. Anesthesiology Department University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany 2. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany 3. Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany 4. Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland 5. Department of Anesthesiology, Kantonsspital Winterthur, Winterthur, Switzerland 6. Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland 7. Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St Gallen, St Gallen, Switzerland 8. Anesthesia and Intensive Care Department, University Hospital, Varese, Italy 9. Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland 10. Department of Anesthesiology, Zurich City Hospital, Zurich, Switzerland 11. Department of Anaesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 12. Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College, Kraków, Poland 13. Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium 14. Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland 15. Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom 16. for the METREPAIR NTproBNP Subcohort Investigators
Abstract
ImportanceNearly 16 million surgical procedures are conducted in North America yearly, and postoperative cardiovascular events are frequent. Guidelines suggest functional capacity or B-type natriuretic peptides (BNP) to guide perioperative management. Data comparing the performance of these approaches are scarce.ObjectiveTo compare the addition of either N-terminal pro-BNP (NT-proBNP) or self-reported functional capacity to clinical scores to estimate the risk of major adverse cardiac events (MACE).Design, Setting, and ParticipantsThis cohort study included patients undergoing inpatient, elective, noncardiac surgery at 25 tertiary care hospitals in Europe between June 2017 and April 2020. Analysis was conducted in January 2023. Eligible patients were either aged 45 years or older with a Revised Cardiac Risk Index (RCRI) of 2 or higher or a National Surgical Quality Improvement Program, Risk Calculator for Myocardial Infarction and Cardiac (NSQIP MICA) above 1%, or they were aged 65 years or older and underwent intermediate or high-risk procedures.ExposuresPreoperative NT-proBNP and the following self-reported measures of functional capacity were the exposures: (1) questionnaire-estimated metabolic equivalents (METs), (2) ability to climb 1 floor, and (3) level of regular physical activity.Main Outcome and MeasuresMACE was defined as a composite end point of in-hospital cardiovascular mortality, cardiac arrest, myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care.ResultsA total of 3731 eligible patients undergoing noncardiac surgery were analyzed; 3597 patients had complete data (1258 women [35.0%]; 1463 (40.7%) aged 75 years or older; 86 [2.4%] experienced a MACE). Discrimination of NT-proBNP or functional capacity measures added to clinical scores did not significantly differ (Area under the receiver operating curve: RCRI, age, and 4MET, 0.704; 95% CI, 0.646-0.763; RCRI, age, and 4MET plus floor climbing, 0.702; 95% CI, 0.645-0.760; RCRI, age, and 4MET plus physical activity, 0.724; 95% CI, 0.672-0.775; RCRI, age, and 4MET plus NT-proBNP, 0.736; 95% CI, 0.682-0.790). Benefit analysis favored NT-proBNP at a threshold of 5% or below, ie, if true positives were valued 20 times or more compared with false positives. The findings were similar for NSQIP MICA as baseline clinical scores.Conclusions and relevanceIn this cohort study of nearly 3600 patients with elevated cardiovascular risk undergoing noncardiac surgery, there was no conclusive evidence of a difference between a NT-proBNP–based and a self-reported functional capacity–based estimate of MACE risk.Trial RegistrationClinicalTrials.gov Identifier: NCT03016936
Publisher
American Medical Association (AMA)
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