Document Detail

Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for the prediction of postoperative cardiac events in noncardiac vascular surgery patients.
MedLine Citation:
PMID:  19322079     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with the presence of coronary artery disease. The aim of this study was to assess the prognostic value of hs-CRP and NT-proBNP for postoperative cardiac events in noncardiac vascular surgery patients. METHODS: In 592 patients, cardiac history, hs-CRP, and NT-proBNP levels were assessed preoperatively. Levels of hs-CRP of at least 6.5 mg/l and NT-proBNP of at least 350 pg/ml were defined as the optimal cut-off values for the prediction of postoperative cardiac events. The end point was the composite of 30-day cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariable regression analysis was used to evaluate the association between hs-CRP, NT-proBNP and the end point. The performance of the risk models based on cardiac risk factors alone and the addition of both biomarkers was determined using C statistics. RESULTS: After adjustment for cardiac risk factors, site of surgery and type of procedure, elevated levels of hs-CRP (odds ratio 2.54; 95% confidence interval 1.50-4.30) and NT-proBNP (odds ratio 4.78; 95% confidence interval 2.71-8.42) remained independent predictors for postoperative cardiac events. When hs-CRP and NT-proBNP were added to the cardiac risk score, the C statistic improved from 0.79 to 0.84. A combined elevation of hs-CRP and NT-proBNP provided a seven-fold higher risk for postoperative cardiac events. CONCLUSION: Both hs-CRP and NT-proBNP have additional value in the prediction of postoperative cardiac events in vascular surgery patients. Their integrated use improves cardiac risk stratification.
Dustin Goei; Sanne E Hoeks; Eric Boersma; Tamara A Winkel; Martin Dunkelgrun; Willem-Jan Flu; Olaf Schouten; Jeroen J Bax; Don Poldermans
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Coronary artery disease     Volume:  20     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-23     Completed Date:  2009-06-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  219-24     Citation Subset:  IM    
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Biological Markers / blood
C-Reactive Protein / metabolism*
Heart Diseases / blood,  etiology*
Logistic Models
Middle Aged
Natriuretic Peptide, Brain / blood*
Odds Ratio
Peptide Fragments / blood*
Predictive Value of Tests
ROC Curve
Risk Assessment
Risk Factors
Vascular Surgical Procedures / adverse effects*
Young Adult
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein

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