Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study.

BACKGROUND

Postoperative atrial fibrillation (POAF) is associated with clinically significant short- and long-term complications after noncardiac surgery. Our aim was to describe the incidence of clinically important POAF after noncardiac surgery and establish the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in this context.

METHODS

The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study was a prospective cohort study involving patients aged 45 years and older who had inpatient noncardiac surgery that was performed between August 2007 and November 2013. We determined 30-day incidence of clinically important POAF (i.e., resulting in angina, congestive heart failure, symptomatic hypotension or requiring treatment) using logistic regression models to analyze the association between preoperative NT-proBNP and POAF.

RESULTS

In 37 664 patients with no history of atrial fibrillation, we found that the incidence of POAF was 1.0% (95% confidence interval [CI] 0.9%-1.1%; 369 events); 3.2% (95% CI 2.3%-4.4%) in patients undergoing major thoracic surgery, 1.3% (95% CI 1.2%-1.5%) in patients undergoing major nonthoracic surgery and 0.2% (95% CI 0.1%-0.3%) in patients undergoing low-risk surgery. In a subgroup of 9789 patients with preoperative NT-proBNP measurements, the biomarker improved the prediction of POAF risk over conventional prognostic factors (likelihood ratio test

INTERPRETATION

We determined that the incidence of clinically important POAF after noncardiac surgery was 1.0%. We also found that preoperative NT-proBNP levels were associated with POAF independent of established prognostic factors.

Informations de copyright

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Déclaration de conflit d'intérêts

Competing interests: P.J. Devereaux has received grants from Abbott Diagnostics, Boehringer Ingelheim, Roche Diagnostics and Siemens, as well as a grant and products from Philips Healthcare outside the submitted work. Emmanuelle Duceppe has received an investigator-initiated grant and a donation-in-kind (assays) from Roche Diagnostics during the conduct of the study. She also received an investigator-initiated grant and a donation-in-kind (assays) from Abbott Laboratories, and an investigator-initiated grant from Boehringer Ingelheim outside of the submitted work. Pablo Alonso-Coello’s institution received funding from the Instituto de Salud Carlos III (Madrid, Spain) and Fundació La Marató de TV3 (Esplugues de Llobregat, Spain). No other competing interests were declared.