Clinical question: Does adding N-terminal pro–B-type natriuretic peptide (NT-proBNP) to clinical risk scores provide a better estimate of the risk of major adverse cardiac events (MACE) among patients undergoing noncardiac surgery (NCS) than the addition of self-reported functional capacity?
Background: Guidelines recommend using functional capacity or B-type natriuretic peptides to guide perioperative management, but limited data compare the performance of these approaches.
Study design: Prospective cohort study
Setting: 25 hospitals in Europe across 10 countries
Synopsis: 3,597 patients undergoing elevated-risk NCS were enrolled between June 2017 and April 2020. The primary endpoint of in-hospital MACE occurred in 86 patients (2.4%). The addition of NT-proBNP to a clinical risk score model increased discrimination for in-hospital MACE. The discrimination gained from the addition of self-reported functional capacity to the clinical risk score model did not reach statistical significance. The discrimination of the two models (adding NT-proBNP, versus functional capacity, to the clinical risk score) did not significantly differ. Decision analysis demonstrated that models incorporating NT-proBNP offered a net benefit over those using functional capacity measures but found the benefit to be marginal. Study limitations include lack of external validation, possible selection bias due to nonrandomized design, and heterogeneity of the surgical procedures and perioperative management.
Bottom line: NT-proBNP may improve the estimation of in-hospital MACE risk after NCS but may be no better at doing so than self-reported functional capacity.
Citation: Buse GL, Larmann J, et al. NT-proBNP or self-reported functional capacity in estimating risk of cardiovascular events after noncardiac surgery. JAMA Netw Open. 2023;6(11):e2342527. doi:10.1001/jamanetworkopen.2023.42527
Dr. Jordan
Dr. Jordan is a hospitalist in the division of hospital medicine at the Mount Sinai Health System and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.