N-terminal pro-B-type natriuretic peptide is an independent predictor of all-cause mortality and MACE after major vascular surgery in medium-term follow-up

Sriram Rajagopalan, Bernard L Croal, Paul Bachoo, Graham Hillis, Julie Brittenden

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OBJECTIVE: Recent interest has focussed on the role of biomarkers to predict outcome in patients undergoing major vascular surgery. We wished to determine if pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels could predict all-cause mortality (ACM; primary aim) and major adverse cardiac event (MACE) (secondary aim) in the medium-term follow-up in patients who have undergone elective major vascular surgery. METHOD: Patients who underwent major elective vascular surgery (n = 136) were followed up for up to 2 years. ACM and first MACE episode were identified from the case notes and the patient management system database of the hospital intranet. RESULTS: One patient was lost to follow-up. In the mean follow-up of 654 days, 27 (20%) died and 23 (17%) patients suffered a MACE. Receiver operator curve (ROC) analysis showed that a pre-operative NT-pro-BNP level with a cut-off of 359 pg ml(-1) had a sensitivity and specificity of 73% each (area under the curve (AUC) 80%, p < 0.001) in predicting ACM and sensitivity of 74% and specificity of 71% (AUC 75%, p < 0.001) to detect a MACE. The overall 2-year survival rate was 84%, 93% in the <359 pg ml(-1) group and 68% in the ≥359 pg ml(-1) group (p < 0.001). Following multivariate analysis, pre-operative NT-pro-BNP at a value of ≥359 pg ml(-1) remained an independent predictor of ACM (odds ratio 3.6 (confidence interval (CI): 1.6-8.1), p = 0.002) Postoperative NT-pro-BNP was a predictor of mortality but not a MACE. CONCLUSION: This study has shown that pre-operative NT-pro-BNP is an independent predictor of ACM and MACE on medium-term follow-up.
Original languageEnglish
Pages (from-to)657-662
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Issue number5
Early online date16 Feb 2011
Publication statusPublished - May 2011



  • bnp
  • N-terminal pro-B-type natriuretic peptide
  • all-cause mortality
  • major adverse cardiac event
  • medim-term outcome

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