NT-Pro BNP Predicts Myocardial Injury Post-Vascular Surgery and is Reduced with CoQ10: A Randomized Double-Blind Trial

Abstract Background NT-Pro BNP levels provide incremental value in perioperative risk assessment prior to major non-cardiac surgery. Whether they can be pharmacologically modified in patients prior to an elective vascular operation is uncertain. Methods A double-blind randomized controlled trial was implemented at a single institution. Patients were screened during their preoperative vascular clinic appointment and randomly assigned to CoQ10 (400 mg per day) versus Placebo for 3 days prior to surgery. Biomarkers including NT-Pro BNP, troponin I and C-reactive protein were obtained prior to and following surgery for up to 48 hours. The primary end-point was postoperative NT-Pro BNP levels and secondary end-point measures included myocardial injury, defined by an elevated cardiac troponin level and length of stay. Results One hundred and twenty-three patients were randomized to receive either CoQ10 (N=62) versus Placebo (N=61) for 3 days before vascular surgery. Preoperative cardiac risks included ischemic heart disease (N=52), CHF (N=12), stroke (N=23) and diabetes mellitus (N=48) and the planned vascular procedures were infra-inguinal (N=78), carotid (N=36), and intraabdominal (N=9). There were no intergroup differences in these clinical variables. NT-Pro BNP levels (median; IQs) in the CoQ10 and Placebo groups were 179 (75-347) and 217 (109-585) pg/ml respectively (P=0.08) preoperatively and 397 (211-686) and 591 (288-1433) pg/ml respectively (P=0.01) at 24 hours following surgery. Patients with an elevated NT-Pro BNP had a higher incidence of myocardial injury, (58% versus 20%; P Conclusions NT-Pro BNP levels predict adverse events post-vascular surgery and are lowered in those patients assigned to preoperative administration of CoQ10.