Predic'ng the occurrence of major adverse cardiac events within 30 days a9er a pa'ent’s vascular surgery
An Individual Pa,ent Data Meta-‐Analysis Thuva Vanniyasingam R. Rodseth, G. Lura, Buse, D. Bolliger, C. Burkhart, B. Cuthbertson, S. Gibson, E. Mahla, D. Leibowitz, B. Biccard
Under the Supervision of Lehana Thabane
Introduc,on u Natriure,c pep,des (NPs) u BNP u NTproBNP
Introduc,on u Natriure,c pep,des (NPs) u BNP u NTproBNP u
MACE = Major Adverse Cardiac Events = Cardiac Death OR Myocardial Infarc,on
Introduc,on u Natriure,c pep,des (NPs) u BNP u NTproBNP u
MACE = Major Adverse Cardiac Events = Cardiac Death OR Myocardial Infarc,on
u Rodseth’s Findings: o Iden,fied pre-‐opera,ve NP cutpoints using the ROC curve method o Cutpoints significantly improved predic,ve performance of the RCRI
Objec'ves CLINICAL OBJECTIVES: 1. Determine an op'mal
threshold values for BNP and NTproBNP
2. Create a model to predict MACE within 30 days
aUer a vascular surgery
STATISTICAL OBJECTIVES: 1. Employ the minimum p-‐value method to dichotomize BNP and NTproBNP and compare with ROC curve approach 2. Determine and validate a predic,on model with a MACE outcome 3. Examine the robustness of the final predic,on model
DESCRIPTION OF DATA TOTALS: BNP (N=632) NTproBNP (N=218)
First Author, Year
With MACE n (%) 2(3%)
Study
BNP or NTproBNP
N
1
BNP
70
Cuthbertson et al., 2007
2
BNP
129
Gibson et al., 2007
3
BNP
3
4
BNP
133
Bolliger et al., 2009
4(3%)
5
BNP
297
Biccard et al.,2011
26(9%)
6
NTproBNP
218
Mahla et al., 2007
19(9%)
Leibowitz et al., 2008
22(17%) 2(67%)
DESCRIPTION OF DATA TOTALS: BNP (N=632) NTproBNP (N=218)
First Author, Year
With MACE n (%) 2(3%)
Study
BNP or NTproBNP
N
1
BNP
70
Cuthbertson et al., 2007
2
BNP
129
Gibson et al., 2007
3
BNP
3
4
BNP
133
Bolliger et al., 2009
4(3%)
5
BNP
297
Biccard et al.,2011
26(9%)
6
NTproBNP
218
Mahla et al., 2007
19(9%)
Leibowitz et al., 2008
22(17%) 2(67%)
PATIENT CHARACTERISTICS Variable
Total (n=850)
MACE (n=75)
65.4 (12.1) 69.4 (8.8) Age (yrs): mean(SD) 391 (46.0) 36 (48.0) Sex (men): n(%) 218 (26.0) +missing Type of Vascular Surgery: n(%) 629 (74.0) 50 (66.7) a) Infrainguinal 217 (25.5) 25 (33.3) b) Aortoiliac 4 (0.5) 0 c) Not specified RCRI Class: n(%) 320 (37.6) 19 (25.3) a) Low (RCRI 0) b) Intermediate 476 (56.0) 45 (60.0) (RCRI 1 or 2) 54 (6.4) 11 (14.7) c) High (RCRI 3) RCRI Components: n(%) 327 (38.5) 42 (56.0) Coronary artery disease 64 (7.5) 14 (18.7) Congestive cardiac failure 145 (17.1) 8 (10.7) Cerebrovascular disease 204 (24.0) 25 (33.3) Diabetes mellitus 28 (3.3) 6 (8.0) Creatinine (≥2 mg/dl)
NO MACE (n=775)
P-Value
65.0 (12.3) 355(45.8)
Test Test Statistic 3.07 T-Test 0.15 P. Chi
0.002 0.696
2.95 P. Chi
12.5 P. Chi
10.68 P. Chi 14.65 P. Chi 2.38 P. Chi 3.93 P. Chi 5.72 P. Chi
0.229 579 (74.7) 192 (24.8) 4 (0.5) 0.002 301 (38.8) 431 (55.6)
43 (5.5) 285 (36.8) 50 (6.5) 137 (17.7) 179 (23.1) 22 (2.8)
0.001
