Abstract 14506: N-Terminal B-Type Natriuretic Peptide (NT-proBNP) and High Sensitive Troponin T for Assessment of Perioperative Cardiac Risk in Major Non Cardiac Surgery
Background: It was the aim of the present study to evaluate the incremental value of the cardiac markers NT-proBNP and high sensitive troponin T for risk prediction prior to non-cardiac surgery.
Methods: In this prospective, international multicenter observational study, patients prior to non emergent non cardiac surgery have been enrolled. Predefined endpoints were inhospital mortality, and the combination of death, acute myocardial infarction, cardiac arrest, cardio-pulmonary resuscitation and acute decompensated heart failure (MACE). Secondary endpoints were total length of hospital stay and days at intensive care. Blood draw was performed within 4 days prior to surgery.
Results: 979 patients were enrolled. 25 patients (2.6%) deceased and 36 (3.7%) of the patients experienced the combined endpoint (MACE). There was a significant association of the Lee index to mortality (0.7% Lee index=0; 2.5% Lee index=1 and 5.0% Lee index ≥ 2; p<0.001). Both cardiac markers were elevated in those patients who died as compared to survivors (hsTnT 21 pg/ml vs. 6.9 pg/ml; p<0.001; NT-proBNP 576 pg/ml vs. 166 pg/ml; p<0.001). Both cardiac markers were superior to the revised Lee index with an AUC for hsTnT of 0.809; p<0.001, for NT-proBNP of 0.765; p<0.01 and for the Lee index of 0.658; p=0.007. Applying a cut-off for hsTnT of 14 pg/ml and for NT-proBNP of 300 pg/ml, those patients with elevated hsTnT had a mortality of 6.9% vs. 1.2% (p<0.001) and with elevated NT-proBNP 4.8% vs. 1.4% (p=0.002). Combining both markers, mortality was 1.1%, 2.3% and 8.4% if 0, only 1 or both markers were positive (p<0.001). In a multivariate binary logistic hsTnT was the strongest independent predictor for mortality (HR 4.5 (95% CI 1.8-11.4); p=0.01) together with the Lee index (HR 2.0 (95% CI 1.04-4.03); p=0.039). Similar results were obtained for the combined endpoint (MACE). And for the secondary endpoints.
Conclusion: NT-proBNP and high sensitive troponin T provide strong prognostic information in patients undergoing non cardiac surgery incremental to the widely accepted revised cardiac index. However, hsTnT was superior to NT-proBNP and to the Lee index. Therefore, implementation of high sensitive troponin T for risk stratification prior to non cardiac surgery should be advocated.
- © 2010 by American Heart Association, Inc.