| Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients |
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Ga Ram Lee, Young Do Jeon, Ja Young Jung, Ji Won Min, Seon Young Park, Seung Hun Lee, Jung Ju Sir, Seung Min Choi, Shin Bae Joo, Joong Myung Lee, Hong Soon Lee |
1Department of Internal Medicine, National Medical Center, Seoul, Korea. seo0515@medimail.co.kr
2Cardiovascular Center, National Medical Center, Seoul, Korea.
3Department of Orthopedic Surgery, National Medical Center, Seoul, Korea. |
| 노인 환자에서 정형외과 수술 후 주요 심장 사건의 예측에 있어 혈중 B-type Natriuretic Peptide의 유용성 |
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이가람1,2, 전영도1,2, 정자영1,2, 민지원1,2, 박선영1,2, 이승훈1,2, 서정주1,2 최승민1,2, 주신배1,2, 이중명3, 이홍순1,2 |
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국립중앙의료원 순환기내과1, 심혈관센터2, 정형외과3 |
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| Abstract |
BACKGROUND
The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide (BNP) level in predicting postoperative in-hospital major adverse cardiac events (MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery.
METHODS
Between March 2010 and September 2011, data from 156 patients (aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria.
RESULTS
MACE occurred in 12 patients (7.7%). The BNP level was significantly higher in patients with MACE than in those without (median, 152.0; interquartile range [36.3 to 352.8] pg/mL vs. median, 36.8; interquartile range [15.5 to 98.1] pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score (r=0.300, p=0.001). In a receiver operating characteristic (ROC) analysis for MACE, the ROC for BNP was 0.746 (95% confidence interval, 0.602 to 0.891). At the optimal cut-off point (BNP=110 pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE (odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident.
CONCLUSION
The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery. |
| Key Words:
B-type natriuretic peptide, Orthopedic surgery, Preoperative, Adverse cardiac events |
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