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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?

A Systematic Review and Meta-Analysis of Observational Studies

Ganesan Karthikeyan, MD, DM^_*,,,||, Ross A. Moncur, BSc^¶, Oren Levine, BSc^#, Diane Heels-Ansdell, MSc, Matthew T.V. Chan, MD, MSc^_**, Pablo Alonso-Coello, MD, MSc^,, Salim Yusuf, MBBS, DPhil^_*,,,||, Daniel Sessler, MD, Juan Carlos Villar, MD, PhD^||||, Otavio Berwanger, MD, PhD^¶¶, Matthew McQueen, MB, ChB, PhD^,,||, Anna Mathew, MD^##, Stephen Hill, PhD, Simon Gibson, MD^_***, Colin Berry, MD, Huei-Ming Yeh, MD and P.J. Devereaux, MD, PhD^,,||,_*

^_* Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
Department of Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
Department of Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
^|| Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
^¶ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
^# School of Medicine, Queen's University, Kingston, Ontario, Canada
^_** Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, China
Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Department of Outcomes Research, The Cleveland Clinic, Cleveland, Ohio
^|||| Facultad de Medicina, Universidad de la Sabana, Bogotá, Colombia
^¶¶ Research Institute (IEP-HCor), Hospital do Coração-/HCor, Sao Paulo, Brazil
^## Department of Medicine, University of Western Ontario in London, London, Ontario, Canada
^_*** Department of General and Vascular Surgery, Gartnavel General Hospital, Glasgow, United Kingdom
BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan

View larger version (30K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Flow Chart Showing Selection of Studies *Independent association of pre-operative brain natriuretic peptide (BNP) levels not reported with outcomes of interest, n = 14; data overlapped with other reports, n = 4; 30-day outcomes not available, n = 3; patients did not undergo a surgical procedure, n = 1; patients underwent cardiopulmonary bypass as part of surgery, n = 1; no pre-operative BNP value available, n = 1; BNP analyzed as a continuous variable, n = 1; case report, n = 1.

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Adjusted Odds Ratios for Pre-Operative BNP/NT-proBNP to Predict Cardiovascular Outcomes at 30 Days After Surgery Forest plot showing the individual and pooled adjusted odds ratios from the included studies. BNP = brain natriuretic peptide; CI = confidence interval; NT-proBNP = N-terminal pro–B-type natriuretic peptide.