Does preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide additional predictive value beyond a clinical risk score for vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days?
Ann Intern Med · 2019 · PMID 31869834 · DOI 10.7326/M19-2501
Measuring preoperative NT-proBNP levels can significantly improve the prediction of cardiovascular complications and death after noncardiac surgery.
The question
Does preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide additional predictive value beyond a clinical risk score for vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days?
What they tested
Preoperative NT-proBNP may improve risk prediction in patients undergoing noncardiac surgery.
How they did it
This was a prospective cohort study involving 10,402 patients aged 45 years or older undergoing inpatient noncardiac surgery across 16 hospitals in 9 countries. All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery.
What they found
Compared with NT-proBNP values less than 100 pg/mL, higher levels were associated with increased adjusted hazard ratios for the primary outcome (vascular death and MINS). Specifically, levels of 100 to less than 200 pg/mL had an HR of 2.27, 200 to less than 1500 pg/mL had an HR of 3.63, and 1500 pg/mL or greater had an HR of 5.82. The incidences of the primary outcome for these groups were 12.3%, 20.8%, and 37.5%, respectively. Adding NT-proBNP thresholds to clinical stratification (Revised Cardiac Risk Index) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also significantly associated with 30-day all-cause mortality, with incidences of 0.3% for less than 100 pg/mL, 0.7% for 100 to less than 200 pg/mL, 1.4% for 200 to less than 1500 pg/mL, and 4.0% for 1500 pg/mL or greater.
| <100 pg/mL | 0 | |
|---|---|---|
| 100 to <200 pg/mL | 12.3 | |
| 200 to <1500 pg/mL | 20.8 | |
| >=1500 pg/mL | 37.5 |
The incidence of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days increases with higher preoperative NT-proBNP levels.
What it means
Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction beyond the Revised Cardiac Risk Index.
Limitations
External validation of the identified NT-proBNP thresholds in other cohorts would reinforce these findings.
The paper at a glance
| Title | Preoperative NT-proBNP and Cardiovascular Events After Noncardiac Surgery: A Cohort Study |
|---|---|
| Journal | Ann Intern Med |
| Year | 2019 |
| PMID | 31869834 ↗ |
| DOI | 10.7326/M19-2501 ↗ |
| Topic | Cardiovascular & vascular aging |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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NT-proBNP Cardiac Test
Improves cardiovascular risk estimation. Research relevant to this mechanism is indexed on PubMed and linked below; it describes the mechanism rather than this specific product.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). Does preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide additional predictive value beyond a clinical risk score for vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days? [Plain-English summary of Ann Intern Med 2019, PMID 31869834, DOI 10.7326/M19-2501]. Magellan Longevity. https://magellanlongevity.com/study/d31869834.html@misc{magellan_d31869834,
title = {Does preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide additional predictive value beyond a clinical risk score for vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/d31869834.html}},
note = {Plain-English summary of PubMed PMID 31869834; DOI 10.7326/M19-2501; Ann Intern Med 2019. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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