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Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class

BACKGROUND: The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction...

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Autores principales: Vetrugno, Luigi, Langiano, Nicola, Gisonni, Renato, Rizzardo, Alessandro, Venchiarutti, Paola Enrica, Divella, Michele, Pompei, Livia, Causero, Araldo, Rocca, Giorgio Della
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998048/
https://www.ncbi.nlm.nih.gov/pubmed/24655733
http://dx.doi.org/10.1186/1471-2253-14-20
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author Vetrugno, Luigi
Langiano, Nicola
Gisonni, Renato
Rizzardo, Alessandro
Venchiarutti, Paola Enrica
Divella, Michele
Pompei, Livia
Causero, Araldo
Rocca, Giorgio Della
author_facet Vetrugno, Luigi
Langiano, Nicola
Gisonni, Renato
Rizzardo, Alessandro
Venchiarutti, Paola Enrica
Divella, Michele
Pompei, Livia
Causero, Araldo
Rocca, Giorgio Della
author_sort Vetrugno, Luigi
collection PubMed
description BACKGROUND: The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date. METHODS: The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge. RESULTS: MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point ≥ 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point ≥ 69 pg/mL gave an AUC of 0.82. CONCLUSIONS: Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.
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spelling pubmed-39980482014-04-25 Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class Vetrugno, Luigi Langiano, Nicola Gisonni, Renato Rizzardo, Alessandro Venchiarutti, Paola Enrica Divella, Michele Pompei, Livia Causero, Araldo Rocca, Giorgio Della BMC Anesthesiol Research Article BACKGROUND: The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date. METHODS: The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge. RESULTS: MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point ≥ 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point ≥ 69 pg/mL gave an AUC of 0.82. CONCLUSIONS: Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery. BioMed Central 2014-03-21 /pmc/articles/PMC3998048/ /pubmed/24655733 http://dx.doi.org/10.1186/1471-2253-14-20 Text en Copyright © 2014 Vetrugno et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Vetrugno, Luigi
Langiano, Nicola
Gisonni, Renato
Rizzardo, Alessandro
Venchiarutti, Paola Enrica
Divella, Michele
Pompei, Livia
Causero, Araldo
Rocca, Giorgio Della
Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title_full Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title_fullStr Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title_full_unstemmed Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title_short Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class
title_sort prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of b-type natriuretic peptide, the revised cardiac risk index, and asa class
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998048/
https://www.ncbi.nlm.nih.gov/pubmed/24655733
http://dx.doi.org/10.1186/1471-2253-14-20
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