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The influence of clinical risk factors on pre‐operative B‐type natriuretic peptide risk stratification of vascular surgical patients
Author(s) -
Biccard B. M.,
Lurati Buse G. A.,
Burkhart C.,
Cuthbertson B. H.,
Filipovic M.,
Gibson S. C.,
Mahla E.,
Leibowitz D. W.,
Rodseth R. N.
Publication year - 2012
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2011.06958.x
Subject(s) - medicine , natriuretic peptide , risk stratification , risk factor , risk assessment , cardiology , heart failure , computer security , computer science
Summary The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre‐operative B‐type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B‐type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p < 0.05 for > 0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with pre‐operative B‐type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B‐type natriuretic peptide stratification (OR 5.1, 95% CI 1.8–15 for the intermediate class, and OR 25, 95% CI 8.7–70 for the high‐risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B‐type natriuretic peptides.