Influence of Renal Function on the Usefulness of N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Cardiac Risk Marker in Patients Undergoing Noncardiac Vascular Surgery

• Published in: The American journal of cardiology Vol. 101; no. 1; pp. 122 - 126
• Main Authors: Goei, Dustin, MD, Schouten, Olaf, MD, Boersma, Eric, PhD, Welten, Gijs M.J.M., MD, Dunkelgrun, Martin, MD, Lindemans, Jan, MD, van Gestel, Yvette R.B.M., MSc, Hoeks, Sanne E., MSc, Bax, Jeroen J., MD, Poldermans, Don, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiovascular; Death, Sudden, Cardiac - epidemiology; Electrocardiography; Female; Glomerular Filtration Rate; Heart attacks; Humans; Kidneys; Male; Medical prognosis; Medical sciences; Middle Aged; Multivariate Analysis; Myocardial Infarction - epidemiology; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Renal Insufficiency - blood; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures; Brain natriuretic peptide; Vascular surgery; Renal function; Prognosis; Cardiovascular risk; N terminal-Sequence; Biological marker; Cardiovascular disease; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.07.058

N-terminal pro-B-type natriuretic peptide (NT–pro-BNP) is related to stress-induced myocardial ischemia and/or volume overload, both common in patients with renal dysfunction. This might compromise the prognostic usefulness of NT–pro-BNP in patients with renal impairment before vascular surgery. We assessed the prognostic value of NT–pro-BNP in the entire strata of renal function. In 356 patients (median age 69 years, 77% men), cardiac history, glomerular filtration rate (GFR, ml/min/1.73 m2 ), and NT–pro-BNP level (pg/ml) were assessed preoperatively. Troponin T and electrocardiography were assessed postoperatively on days 1, 3, 7, and 30. The end point was the composite of cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariate analysis was used to evaluate the interaction between GFR, NT–pro-BNP and their association with postoperative outcome. Median GFR was 78 ml/min/1.73 m2 and the median concentration of NT–pro-BNP was 197 pg/ml. The end point was reached in 64 patients (18%); cardiac death occurred in 7 (2.0%), Q-wave myocardial infarction in 34 (9.6%), and non–Q-wave myocardial infarction in 23 (6.5%). After adjustment for confounders, NT–pro-BNP levels and GFR remained significantly associated with the end point (p = 0.005). The prognostic value of NT–pro-BNP was most pronounced in patients with GFR ≥90 (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.80 to 1.76) compared with patients with GFR 60 to 89 (OR 1.04, 95% CI 1.002 to 1.07), and with GFR 30 to 59 (OR 1.12, 95% CI 1.03 to 1.21). In patients with GFR <30 ml/min/1.73 m2 , NT–pro-BNP levels have no prognostic value (OR 1.00, 95% CI 0.99 to 1.01). In conclusion, the discriminative value of NT–pro-BNP is most pronounced in patients with GFR ≥90 ml/min/1.73 m2 and has no prognostic value in patients with GFR <30 ml/min/1.73 m2.