Predictive value of plasma N-terminal pro B-type natriuretic peptide for early major adverse cardiac event following elective vascular interventions

Abstract

Objective: Vascular interventions are associated with a substantial risk of major adverse cardiovascular events (MACEs) in perioperative period. We aimed to analyze the predictive value of plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) for early MACE following elective vascular intervention. Materials and Methods: We conducted a single-center, prospective, observational study at Jain Institute of Vascular Sciences, Bengaluru. One hundred and two patients undergoing elective vascular intervention were enrolled in the study. Results: A total of nine patients had MACE comprising seven acute coronary syndromes, one atrial fibrillation, and one congestive cardiac failure in perioperative period. Three patients had MACE preoperatively. Mean age was higher in MACE group (68 years vs. 62 years, P = 0.21). Receiver operator curve analysis demonstrated NT-ProBNP threshold cutoff> 1580 ng/ml and> 2020 ng/ml, pre- and post-operatively. In patients with MACE, mean plasma concentration of pre- and post-operative NT-proBNP was 13,293.34 ng/L and 5628.84 ng/L compared to non-MACE group of 664.60 ng/L and 818.75 ng/L, respectively. Positive and negative predictive values for pre- and post-operative NT-proBNP were 24%, 98.5% and 33%, 98.8%, respectively. Conclusion: Presence of hypertension and elevated pre- and post-operative NT-proBNP values is significantly associated with higher incidence of early MACE (30 days) and is not influenced by age, gender, and previous coronary artery disease. NT-proBNP can be considered for the quantification of perioperative cardiac risk in vascular surgery patients.

Keywords

• Cardiac event
• elective vascular intervention
• major adverse cardiovascular events
• N-terminal pro B-type natriuretic peptide