Southern African Journal of Anaesthesia and Analgesia

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Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

L Ryan, C Rajah, Dale Simmers, Danielle Potgieter, Reitze N Rodseth


Background: A plethora of studies have shown elevated preoperative natriuretic peptide measurements to predict postoperative mortality and adverse cardiac events.
Objectives: The current study aimed to demonstrate this overwhelming association and to show that further studies of this nature are unwarranted.
Methods: A cumulative meta-analysis of 28 studies was conducted where the primary outcomes of  mortality and adverse cardiac events were associated with elevated preoperative natriuretic peptides.
Results: Cumulative meta-analysis demonstrated an odds ratio trending to a constant of 5.66, with a marked narrowing in the 95% confidence interval.
Conclusions: Further studies aiming only to demonstrate an association between a preoperative natriuretic peptide threshold and the risk of postoperative adverse cardiac events are not justified. Future investigation should focus on the clinical implications of these data and the application of these findings with regard to further investigation, optimisation and appropriate adaptation of perioperative management.

Keywords: BNP, major adverse cardiac event, myocardial injury, natriuretic peptides, non-cardiac surgery, NT-proBNP, outcomes
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