Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 136; no. 2; pp. 452 - 461
• Main Authors: Fox, Amanda A., MD, Shernan, Stanton K., MD, Collard, Charles D., MD, Liu, Kuang-Yu, PhD, Aranki, Sary F., MD, DeSantis, Stacia M., PhD, Jarolim, Petr, MD, PhD, Body, Simon C., MBChB, MPH
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-08-2008; AATS/WTSA; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Assisted Circulation; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiothoracic Surgery; Cardiotonic Agents - therapeutic use; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary heart disease; Female; Heart; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Pneumology; Postoperative Care; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Ventricular Dysfunction - diagnosis; Ventricular Dysfunction - etiology; CHF; intra-aortic balloon pump; cTnI; IABP; POD; postoperative day; BNP; CI; LVEF; left ventricular ejection fraction; cardiac troponin I; ventricular assist device; 1; B-type natriuretic peptide; CPB; cardiopulmonary bypass; VAD; congestive heart failure; confidence interval; CABG; coronary artery bypass grafting; Brain natriuretic peptide; Prognosis; Predictor; Mortality; Prediction; Cardiovascular disease; Coronary heart disease; Epidemiology; Coronary artery bypass; Dysfunction; Primary; Anesthesia; Graft; Circulatory system; Preoperative; Cardiology; Predictive factor
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.12.036

Objective Elevated B-type natriuretic peptide is associated with increased morbidity and mortality in ambulatory patients with congestive heart failure or acute coronary syndromes. Its utility in predicting adverse cardiac surgical outcomes is less certain. We hypothesized that preoperative plasma B-type natriuretic peptide would independently predict in-hospital postoperative ventricular dysfunction, hospital stay, and up to 5-year mortality after primary coronary artery bypass grafting. Methods This is a prospective, longitudinal study of 1023 patients at two institutions undergoing primary coronary artery bypass grafting with cardiopulmonary bypass. Ventricular dysfunction was defined as requirement for at least two inotropes or new intra-aortic balloon pump or ventricular assist device support after coronary artery bypass grafting. Multivariable analyses assessed independent roles of preoperative B-type natriuretic peptide in predicting postoperative ventricular dysfunction, hospital stay, and 5-year all-cause mortality. Results Preoperative plasma B-type natriuretic peptide concentration predicted ventricular dysfunction, hospital stay, and mortality in univariate and multivariable analyses. Logistic regression demonstrated preoperative B-type natriuretic peptide to independently predict ventricular dysfunction (odds ratio 1.92, 95% confidence interval 1.12–3.29, P = .018), after adjustment for preoperative left ventricular ejection fraction, congestive heart failure severity, and other clinical predictors. Multivariable Cox proportional hazards models showed preoperative B-type natriuretic peptide to independently predict hospital stay (hazard ratio 1.42, 95% confidence interval 1.18–1.72, P = .0002) and mortality (hazard ratio 1.89, 95% confidence interval 1.08–3.33, P = .026). Conclusion Preoperative plasma B-type natriuretic peptide independently predicted in-hospital ventricular dysfunction, hospital stay, and up to 5-year all-cause mortality after primary coronary artery bypass grafting.