The prognostic usefulness of the cardiac biomarkers N-terminal pro-brain natriuretic
peptide (NT-proBNP) and angiotensin-converting enzyme 2 (ACE-2), in predicting adverse
cardiac outcomes after orthopedic surgery is not well studied. The aim of our study
was to determine the usefulness of perioperative NT-proBNP and ACE-2 for predicting
cardiac events after emergency orthopedic surgery. The perioperative NT-proBNP and
ACE-2 levels were determined in 187 consecutive patients aged >60 years who underwent
orthopedic surgery with 1 year of follow-up for any cardiac complications (defined
as acute myocardial infarction, congestive cardiac failure, atrial fibrillation, or
major arrhythmia) and death. Of the 187 patients, 20 (10.7%) sustained an in-hospital
postoperative cardiac complication. The total all-cause in-hospital and 1-year mortality
rate was 1.6% (3 of 187) and 8.6% (16 of 187), respectively. The median preoperative
and postoperative NT-proBNP level was greater in patients who sustained an in-hospital
cardiac event than in those who had not (386 vs 2,273 pg/ml, p <0.001, and 605 vs
4,316 pg/ml, p <0.001, respectively). Similarly, the postoperative median ACE-2 levels
were significantly greater in the patients with an in-hospital cardiac event than
in those without (25.3 vs 39.5 pmol/ml/min, p = 0.012). A preoperative NT-proBNP level
of ≥741 pg/ml (odds ratio 4.5, 95% confidence interval 1.3 to 15.2, p = 0.017), postoperative
troponin elevation (odds ratio 4.9, 95% confidence interval 1.3 to 18.9, p = 0.022),
and number of co-morbidities (odds ratio 1.8, 95% confidence interval 1.2 to 2.8,
p = 0.009) independently predicted in-hospital cardiac complications on multivariate
analysis. The pre- and postoperative NT-proBNP level independently predicted 1-year
cardiovascular complications but not the ACE-2 levels. In conclusion, elevated perioperative
NT-proBNP predicted in-hospital and 1-year cardiac events in an emergency orthopedic
population but the ACE-2 levels did not, which requires additional study for validation.
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References
- Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients.Heart. 2006; 92: 1645-1650
- Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and perioperative cardiovascular risk in elderly patients.Circ J. 2008; 72: 195-199
- Evaluation of cardiac involvement following major orthopedic surgery.Clivol Chem Lab Med. 2006; 44: 1340-1346
- Usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict postoperative cardiac complications and Long-term mortality after emergency lower limb orthopedic surgery.Am J Cardiol. 2010; 106: 865-872
- Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortality.Crit Care Med. 2006; 34: 995-1000
- N-terminal pro-brain natriuretic peptide identifies patients at high risk for adverse cardiac outcome after vascular surgery.Anesthesiology. 2007; 106: 1088-1095
- Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery.Br J Surg. 2005; 92: 1041-1045
- The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture.Arch Phys Med Rehabil. 2007; 88: 1136-1139
- ACE2, a new regulator of the renin-angiotensin system.Trends Endocrinol Metab. 2004; 15: 166-169
- Myocardial infarction increases ACE2 expression in rat and humans.Eur Heart J. 2005; 26 (322–364): 369-375
- Angiotensin-converting enzyme 2 catalytic activity in human plasma is masked by an endogenous inhibitor.Exp Physiol. 2008; 93: 685-693
- Incidence of post-operative troponin I rises and one year mortality after emergency orthopaedic surgery in older patients.Age Ageing. 2009; 38: 168-174
- Universal definition of myocardial infarction.J Am Coll Cardiol. 2007; 50: 2173-2195
- Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery.Br J Anaesth. 2007; 99: 170-176
- Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery.Heart. 2006; 92: 401-402
- Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass.Am J Cardiol. 2006; 98: 111-115
- Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery.Heart. 2007; 93: 226-231
- Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery?.J Am Coll Cardiol. 2009; 54: 1599-1606
- Pre-operative cardiac risk assessment in noncardiac surgery: Are natriuretic peptides the Magic bullet?.J Am Coll Cardiol. 2009; 54: 1607-1608
- A meta-analysis of the utility of preoperative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients.J Anesth. 2008; 63: 1226-1233
Article info
Publication history
Published online: March 01, 2012
Accepted:
December 11,
2011
Received in revised form:
December 11,
2011
Received:
October 21,
2011
Footnotes
This study was sponsored by a Cardiovascular Lipid grant 2009 from Pfizer, Australia (West Ryde, Australia). Dr. Chong is a recipient of a National Health and Medical Research Council (Canberra, ACT, Australia) postgraduate research scholarship and has received research stipends from the University of Melbourne (Melbourne, Victoria, Australia) and the Northern Clinical Research Centre, Northern Health (Epping, Victoria, Australia).
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Copyright
© 2012 Published by Elsevier Inc. All rights reserved.
