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Influence of Renal Function on the Usefulness of N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Cardiac Risk Marker in Patients Undergoing Noncardiac Vascular Surgery

  • Dustin Goei
    Affiliations
    Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 Dr. Schouten is supported by an unrestricted research grant from the Netherlands Organization of Health Research and Development (ZonMW), The Hague, the Netherlands.
    Olaf Schouten
    Footnotes
    1 Dr. Schouten is supported by an unrestricted research grant from the Netherlands Organization of Health Research and Development (ZonMW), The Hague, the Netherlands.
    Affiliations
    Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Eric Boersma
    Affiliations
    Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Gijs M.J.M. Welten
    Affiliations
    Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    2 Dr. Dunkelgrun is supported by an unrestricted research grant from the Netherlands Heart Foundation, The Hague, The Netherlands (#2003B143).
    Martin Dunkelgrun
    Footnotes
    2 Dr. Dunkelgrun is supported by an unrestricted research grant from the Netherlands Heart Foundation, The Hague, The Netherlands (#2003B143).
    Affiliations
    Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Jan Lindemans
    Affiliations
    Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    3 Drs. Hoeks and van Gestel are supported by an unrestricted research grant from “Lijf & Leven” Foundation, Rotterdam, The Netherlands.
    Yvette R.B.M. van Gestel
    Footnotes
    3 Drs. Hoeks and van Gestel are supported by an unrestricted research grant from “Lijf & Leven” Foundation, Rotterdam, The Netherlands.
    Affiliations
    Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    3 Drs. Hoeks and van Gestel are supported by an unrestricted research grant from “Lijf & Leven” Foundation, Rotterdam, The Netherlands.
    Sanne E. Hoeks
    Footnotes
    3 Drs. Hoeks and van Gestel are supported by an unrestricted research grant from “Lijf & Leven” Foundation, Rotterdam, The Netherlands.
    Affiliations
    Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Jeroen J. Bax
    Affiliations
    Department of Cardiology, University Medical Centre, Leiden, the Netherlands.
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  • Don Poldermans
    Correspondence
    Corresponding author: Tel.: 31-10-463-4613; fax: 31-10-463-4957.
    Affiliations
    Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
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  • Author Footnotes
    1 Dr. Schouten is supported by an unrestricted research grant from the Netherlands Organization of Health Research and Development (ZonMW), The Hague, the Netherlands.
    2 Dr. Dunkelgrun is supported by an unrestricted research grant from the Netherlands Heart Foundation, The Hague, The Netherlands (#2003B143).
    3 Drs. Hoeks and van Gestel are supported by an unrestricted research grant from “Lijf & Leven” Foundation, Rotterdam, The Netherlands.
      N-terminal pro-B-type natriuretic peptide (NT–pro-BNP) is related to stress-induced myocardial ischemia and/or volume overload, both common in patients with renal dysfunction. This might compromise the prognostic usefulness of NT–pro-BNP in patients with renal impairment before vascular surgery. We assessed the prognostic value of NT–pro-BNP in the entire strata of renal function. In 356 patients (median age 69 years, 77% men), cardiac history, glomerular filtration rate (GFR, ml/min/1.73 m2), and NT–pro-BNP level (pg/ml) were assessed preoperatively. Troponin T and electrocardiography were assessed postoperatively on days 1, 3, 7, and 30. The end point was the composite of cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariate analysis was used to evaluate the interaction between GFR, NT–pro-BNP and their association with postoperative outcome. Median GFR was 78 ml/min/1.73 m2 and the median concentration of NT–pro-BNP was 197 pg/ml. The end point was reached in 64 patients (18%); cardiac death occurred in 7 (2.0%), Q-wave myocardial infarction in 34 (9.6%), and non–Q-wave myocardial infarction in 23 (6.5%). After adjustment for confounders, NT–pro-BNP levels and GFR remained significantly associated with the end point (p = 0.005). The prognostic value of NT–pro-BNP was most pronounced in patients with GFR ≥90 (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.80 to 1.76) compared with patients with GFR 60 to 89 (OR 1.04, 95% CI 1.002 to 1.07), and with GFR 30 to 59 (OR 1.12, 95% CI 1.03 to 1.21). In patients with GFR <30 ml/min/1.73 m2, NT–pro-BNP levels have no prognostic value (OR 1.00, 95% CI 0.99 to 1.01). In conclusion, the discriminative value of NT–pro-BNP is most pronounced in patients with GFR ≥90 ml/min/1.73 m2 and has no prognostic value in patients with GFR <30 ml/min/1.73 m2.
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