MiscellaneousN-Terminal Pro-Brain Natriuretic Peptide and Angiotensin-Converting Enzyme-2 Levels and Their Association With Postoperative Cardiac Complications After Emergency Orthopedic Surgery
Section snippets
Methods
The present study was performed in conjunction with a randomized controlled trial randomizing patients who sustained a troponin elevation to usual (standard) care or cardiology care (Australian New Zealand Clinical Trials Registry trial number ACTRN12608000165381). Ethics approval was given by the Northern Hospital Human Research and Ethics Committee, and patients were consecutively recruited from 2008 to 2009.
The patients were recruited from the orthopedic-geriatric unit at Northern Hospital
Results
A total of 383 patients were screened for the present study, and 187 eligible patients were included. The reason for exclusion for most patients was receiving high-level care, undergoing elective surgery, terminal illness, or coexisting severe dementia. Fifteen eligible patients declined involvement in the study. Most patients had preoperative blood samples stored for NT-proBNP analysis (161 [86.1%] of 187). Similarly, most patients had postoperative blood samples available for postoperative
Discussion
The present study found that perioperative NT-proBNP predicted in-hospital and 1-year cardiac events in patients undergoing emergency orthopedic surgery. A preoperative NT-proBNP level of ≥741 pg/ml and postoperative NT-proBNP level of ≥1,064 pg/ml were the optimal cutoff points predicting in-hospital cardiac events using ROC curve analysis. These results are similar to our other observational study of NT-proBNP that recruited patients undergoing lower limb emergency surgery.4 The AUC cutoff
Acknowledgments
We thank the Austin Pathology nurses and pathology staff at The Northern Hospital (Epping, Victoria, Australia), Beckman Coulter (Brea, California), and Austin Pathology (Epping, Victoria, Australia) for complimentary testing of troponin I.
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Cited by (29)
Postoperative troponin release is associated with major adverse cardiovascular events in the first year after noncardiac surgery
2019, International Journal of CardiologyCitation Excerpt :The distinctive feature of our study is the addition of the graded association for MACE with increasing levels of peak troponin in contrast to troponin elevation as a dichotomized value below or above the 99th percentile threshold for the specific assay used. The three studies that reported on the association between postoperative troponin elevation and 1-year MACE, with varying outcome definitions used for adverse cardiac events, were limited to patients undergoing orthopaedic surgery [17–19]. In our study, we included all types of intermediate-to-high risk noncardiac surgery to generate results for a general surgical population.
Predictive value of B-type natriuretic peptide (BNP) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA)
2016, Journal of Orthopaedic ScienceTroponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: A systematic review and meta-analysis
2016, British Journal of AnaesthesiaCitation Excerpt :Funnel plots are provided in the Supplementary material. The unadjusted association between troponin elevation and 30 day mortality after surgery was estimated in eight studies including 1587 patients.12–15 24 26–28 We computed an unadjusted pooled OR of 3.52 (95% CI, 2.21–5.62; I2=0%),12–15 24 26 27 see Fig. 2.
The use of preoperative B-type natriuretic peptide as a predictor of atrial fibrillation after thoracic surgery: Systematic review and meta-analysis
2015, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :A total of 1,008 citations were identified, from which 94 were selected for full-text evaluation. From these, 56 were excluded because they did not record AF as a study outcome (references in Appendix 2), 9 because patients did not have thoracic surgery,7–15 9 because the publications contained retracted or fraudulent data,16–24 4 that had no preoperative NP measurement,25–28 4 that had no surgery being conducted,29–32 3 that were editorials or letters,33–35 2 that dealt with cardiac surgery,36,37 1 that was a meta-analysis,38 and 1 that represented a duplicate cohort.4 The remaining 5 studies were considered eligible for study inclusion.39–43
This study was sponsored by a Cardiovascular Lipid grant 2009 from Pfizer, Australia (West Ryde, Australia). Dr. Chong is a recipient of a National Health and Medical Research Council (Canberra, ACT, Australia) postgraduate research scholarship and has received research stipends from the University of Melbourne (Melbourne, Victoria, Australia) and the Northern Clinical Research Centre, Northern Health (Epping, Victoria, Australia).