Perioperative medicine & outcomes
Preoperative N-terminal pro-B-type natriuretic peptide and myocardial injury after stopping or continuing renin–angiotensin system inhibitors in noncardiac surgery: a prespecified analysis of a phase 2 randomised controlled multicentre trial
Authors' conclusion
Stopping renin-angiotensin system inhibitors in lower-risk patients (preoperative NT-proBNP <100 pg ml -1) increased the likelihood of myocardial injury before noncardiac surgery.
Study context
- Population
- Patients ≥60 yr undergoing elective noncardiac surgery prescribed renin-angiotensin system (RAS) inhibitors, six UK centres
- Participants
- 241 patients
- Comparison
- Stop vs Continue
- Primary endpoint
- Myocardial injury (high-sensitivity troponin-T ≥15 ng L-1 or a ≥5 ng L-1 increase when preoperative high-sensitivity troponin-T ≥15 ng L-1)
- Follow-up
- Within 48 h after surgery
Methodological detailsmulticentre, masked outcome assessment, preplanned analysis
- Multicentre
- Masked outcome assessment
- Preplanned analysis
Primary result
As reported in the abstract
Myocardial injury within 48 h after surgery, by preoperative NT-proBNP (<100 or >100 pg ml-1) and stopping or continuing RAS inhibitors
Odds ratio (95% CI)P value
Stopped RAS inhibitors (NT-proBNP <100 pg ml-1) vs continued RAS inhibitors (NT-proBNP <100 pg ml-1)OR for stopping
2.22(1.06–4.65)
P = 0.03Stopping (NT-proBNP >100 pg ml-1) vs continuing (NT-proBNP >100 pg ml-1)OR for stopping; rates similar
0.98(0.44–2.22)
Further findings
| Outcome | NT-proBNP >100 pg ml-1 | NT-proBNP <100 pg ml-1 | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Myocardial injury by preoperative NT-proBNP (>100 vs <100 pg ml-1) · within 48 h after surgery | 62.4% | 32.1% | 3.50 (2.05–5.99) | P < 0.0001 | |
| 0.20.5125Odds ratio (log scale) |
- Myocardial injury by preoperative NT-proBNP (>100 vs <100 pg ml-1): 101 (41.9%) had NT-proBNP >100 pg ml-1, median 339 [160-833] pg ml-1
Original publication
Preoperative N-terminal pro-B-type natriuretic peptide and myocardial injury after stopping or continuing renin–angiotensin system inhibitors in noncardiac surgery: a prespecified analysis of a phase 2 randomised controlled multicentre trial. Br J Anaesth. Published 9 February 2024. doi:10.
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