23 Dec Biomarker Predicts Perioperative Cardiovascular Complications
MedicalResearch.com Interview with:
Dr. PJ Devereaux MD, PhD, FRCP(C)
Director of the Division of Cardiology
Anesthesiology, Perioperative Medicine, and Surgical Research Group
Population Health Research Institute
MedicalResearch.com: What is the background for this study?
Response: There is an ethical obligation to provide patients with an accurate estimation of the potential benefits of surgery and the potential risks, to facilitate informed decision making about the appropriateness of surgery. There are two common approaches to risk estimation.
First, physicians commonly use clinical risk indices. Based upon a patient’s clinical history (e.g., history of prior heart attack or stroke) an estimate of perioperative risk is determined. Research demonstrates that these clinical risk indices have suboptimal risk discrimination capabilities, and they will underestimate risk in many patients.
The second approach that has commonly been used is to have patients undergo an expensive and time consuming non-invasive cardiac test (e.g., stress nuclear cardiac study). Although these non-invasive cardiac tests can enhance risk estimation in some patients who will have a perioperative cardiac event, these tests more commonly exaggerate risk in patients who will not have a complication.
MedicalResearch.com: What are the main findings?
Response: Preliminary data suggested that a much cheaper test (i.e., the biomarker NT-proBNP) that can be obtained in minutes is more accurate than the clinical risk indices and non-invasive cardiac tests. Because of the limitations of the current approaches to perioperative risk estimation and the encouraging preliminary data that a simple blood test may accurately predict perioperative risk, we undertook this 10,402 patient international prospective cohort study to evaluate the prognostic capabilities of NT-proBNP in patients undergoing non-cardiac surgery.
Our study demonstrated that NT-proBNP strongly differentiates who will and will not experience a perioperative cardiovascular complication. Beyond this, we also demonstrated that NT-proBNP is able to differentiate the risk of mortality in patients undergoing surgery.
MedicalResearch.com: What should readers take away from your report?
Response: We demonstrate that NT-proBNP is able to improve risk prediction in patients who will and will not suffer a major perioperative cardiac event. This is a major advance compared to our two prior approaches to risk estimation. Moreover, the tests is faster and cheaper than non-invasive cardiac tests and even medical consults.
Although our study demonstrates that NT-proBNP can be used to improve perioperative risk prediction and therefore facilitate more informed decision making about the appropriateness of surgery, surgical and anesthestic approaches, and identification of patients who require enhanced monitoring after surgery, there is a need for more research.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are using NT-proBNP to identify patients who are eligible for a large international randomized controlled trial that we are currently conducting. Moreover, we plan to undertake trials informed by patients preoperative NT-proBNP level that will target interventions that we believe can influence the NT-proBNP level and potentially improve patient outcomes.
Disclosures: I a member of a research group with a policy of not accepting honorariums or other payments from industry for our own personal financial gain. We do accept honorariums/payments from industry to support research endeavours and costs to participate in meetings. Based on study questions I have originated and grants I have written, I have received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics and Stryker. I have also participated in an advisory board meeting for GlaxoSmithKline and an expert panel meeting with AstraZeneca, Boehringer Ingelheim, and Roche.
Duceppe E, Patel A, Chan MT, et al. Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study. Ann Intern Med. 2019; [Epub ahead of print 24 December 2019]. doi: https://doi.org/10.7326/M19-2501
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