Department of Vascular Surgery, University of Aberdeen and Aberdeen Royal Infirmary, NHS Grampian, Foresterhill, Aberdeen AB25 2ZN, UK.
Eur J Vasc Endovasc Surg. 2011 May;41(5):657-62. doi: 10.1016/j.ejvs.2010.12.017. Epub 2011 Feb 16.
Recent interest has focussed on the role of biomarkers to predict outcome in patients undergoing major vascular surgery. We wished to determine if pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels could predict all-cause mortality (ACM; primary aim) and major adverse cardiac event (MACE) (secondary aim) in the medium-term follow-up in patients who have undergone elective major vascular surgery.
Patients who underwent major elective vascular surgery (n = 136) were followed up for up to 2 years. ACM and first MACE episode were identified from the case notes and the patient management system database of the hospital intranet.
One patient was lost to follow-up. In the mean follow-up of 654 days, 27 (20%) died and 23 (17%) patients suffered a MACE. Receiver operator curve (ROC) analysis showed that a pre-operative NT-pro-BNP level with a cut-off of 359 pg ml(-1) had a sensitivity and specificity of 73% each (area under the curve (AUC) 80%, p < 0.001) in predicting ACM and sensitivity of 74% and specificity of 71% (AUC 75%, p < 0.001) to detect a MACE. The overall 2-year survival rate was 84%, 93% in the <359 pg ml(-1) group and 68% in the ≥359 pg ml(-1) group (p < 0.001). Following multivariate analysis, pre-operative NT-pro-BNP at a value of ≥359 pg ml(-1) remained an independent predictor of ACM (odds ratio 3.6 (confidence interval (CI): 1.6-8.1), p = 0.002) Postoperative NT-pro-BNP was a predictor of mortality but not a MACE.
This study has shown that pre-operative NT-pro-BNP is an independent predictor of ACM and MACE on medium-term follow-up.
近期的研究热点集中于生物标志物在接受大血管手术的患者中的作用，以预测其预后。我们希望确定在接受择期大血管手术的患者中，术前和术后 N 末端脑钠肽前体（NT-pro-BNP）水平是否可以预测全因死亡率（主要目标）和主要不良心脏事件（次要目标）的中期随访结果。
对 136 例接受择期大血管手术的患者进行随访，随访时间长达 2 年。通过病历和医院内部网患者管理系统数据库确定全因死亡率和首次主要不良心脏事件。
1 例患者失访。在平均 654 天的随访中，27 例（20%）死亡，23 例（17%）患者发生主要不良心脏事件。受试者工作特征曲线（ROC）分析显示，术前 NT-pro-BNP 水平的截断值为 359pg/ml 时，其预测全因死亡率的灵敏度和特异度均为 73%（曲线下面积（AUC）为 80%，p<0.001），预测主要不良心脏事件的灵敏度为 74%，特异度为 71%（AUC 为 75%，p<0.001）。2 年总体生存率为 84%，<359pg/ml 组为 93%，≥359pg/ml 组为 68%（p<0.001）。多变量分析后，术前 NT-pro-BNP 水平≥359pg/ml 仍然是全因死亡率的独立预测因子（比值比 3.6（95%置信区间（CI）：1.6-8.1），p=0.002）。术后 NT-pro-BNP 是死亡率的预测因子，但不是主要不良心脏事件的预测因子。
本研究表明，术前 NT-pro-BNP 是预测中期随访全因死亡率和主要不良心脏事件的独立指标。
