Background Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. Objective To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. Design Prospective cohort study. Setting 16 hospitals in 9 countries. Patients 10 402 patients aged 45 years or older having inpatient noncardiac surgery. Measurements All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery. Results In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]). Limitation External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. Conclusion Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI. Primary Funding Source Canadian Institutes of Health Research.

中文翻译：

---

非心脏手术后的术前N末端Pro-B型利钠肽和心血管事件：一项队列研究。

背景初步数据表明，术前N末端前B型利钠尿肽（NT-proBNP）可以改善非心脏手术患者的风险预测。目的确定术前NT-proBNP是否对非心脏手术后30天内的血管死亡和心肌损伤复合物具有超过临床风险评分的其他预测价值。设计前瞻性队列研究。在9个国家/地区设有16家医院。患者10 402名年龄在45岁或以上的患者接受了住院非心脏手术。测量所有患者均在手术前3天每天测量NT-proBNP水平，每天测量肌钙蛋白T水平。结果在多变量分析中，与术前NT-proBNP值小于100 pg / mL（参考组）相比，100到小于200 pg / mL，200到小于1500 pg / mL以及1500 pg / mL或更高的那些与调整后的危险比2.27（95％CI，1.90至2.70），3.63（CI，3.13）相关至4.21）和5.82（CI，从4.81至7.05），相应的主要结局发生率分别为12.3％（1843年的226），20.8％（2608的542）和37.5％（595的223）。在临床分层中增加NT-proBNP阈值（即修订后的心脏风险指数[RCRI]），每1000名患者的绝对绝对分类净改善为258。术前NT-proBNP值也与30天全因死亡率显着相关（小于100 pg / mL [发生率，0.3％]，100至小于200 pg / mL [发生率，0.7％]，200至更低大于1500 pg / mL [发生率，1.4％]和1500 pg / mL或更高[发生率，4.0％]）。局限性其他队列中已确定的NT-proBNP阈值的外部验证将加强我们的发现。结论术前NT-proBNP与非心脏手术后30天内的血管死亡和MINS密切相关，除RCRI外，还可以改善心脏风险预测。主要资金来源加拿大卫生研究院。