The usefulness of N-terminal pro-brain natriuretic peptide and cardiac troponin measurement in the prediction of cardiac morbidity after carotid endarterectomy

Abstract

Background. The purpose of the study was to assess whether preoperative and postoperative N-terminal fragments of B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) measurements could be used to identify patients at risk of early adverse cardiac events after carotid endarterectomy (CEA).
Material and methods. The study was a prospective single-centre observational cohort of 100 patients undergoing CEA. Blood samples were obtained for plasma Nt-proBNP and cTnI one day before surgery and on postoperative day 1. Early cardiac complications including cardiac death, myocardial infarction, unstable angina, heart failure, and serious arrhythmias occurring within the period of 30 days after the operation were registered.
Results. During the follow-up period 10 patients (10%) suffered from serious cardiac complications. The NT-proBNP levels increased in 77 patients up to a mean value of 980.580 pg/ml (SD = 2109.606), and the difference between two measurements was statistically significant (p < 0.000001). The discriminate 462 pg/ml preoperative level of NT-proBNP was associated with early cardiac complication (p = 0.021). The cTnI level increased in 12 patients to a mean of 0.069 ug/l (SD = 0.360). The troponin elevation was not statistically significant. Increases in the postoperative cTnI concentrations correlated with the total 30-day cardiac complication rate (p = 0.045).
Conclusions. The preoperative level of the N-terminal fragment of B-type natriuretic peptide (but not postoperative) could be used as a predictor of early postoperative cardiac complications after CEA. The serial cardiac troponin I measurement may be helpful to show patients at risk of myocardial infarction after being discharged from hospital.
Acta Angiol 2011; 17, 3: 199–208