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Preoperative NT-proBNP independently predicts outcome in patients with acute coronary syndrome undergoing CABG
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
University of Örebro, Sweden .
Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
University of Örebro, Sweden .
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2013 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 1, 28-35 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. The predictive value of preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated in patients with acute coronary syndrome undergoing coronary artery bypass grafting (CABG). Design. As a substudy to a clinical trial 383 patients with acute coronary syndrome undergoing CABG were studied. 17 patients had a concomitant procedure. NT-proBNP was measured immediately preoperatively and evaluated with regard to in-hospital mortality, and severe circulatory failure postoperatively according to prespecified criteria. Follow-up was 3.2 +/- 0.9 years. Results. In patients with isolated CABG, receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.82 for in-hospital mortality and 0.87 for severe circulatory failure respectively with a best cut-off for preoperative NT-proBNP of 1028 ng/L. This cut-off level independently predicted severe circulatory failure. Patients with NT-proBNP andlt; 1028 ng/L had significantly better long-term survival (p = 0.004). Preoperative NT-proBNP was higher in patients with concomitant procedure than isolated CABG (2146 +/- 1858 v 887 +/- 1635 ng/L; p = 0.0005). In patients with concomitant procedure ROC analysis showed an AUC of 0.93 for severe circulatory failure with a best cut-off for preoperative NT-proBNP of 3145 ng/L. Conclusions. Preoperative NT-proBNP predicted in-hospital mortality, severe circulatory failure postoperatively and long-term survival in patients undergoing surgery for acute coronary syndrome but a higher threshold was found in patients having concomitant procedures.

Place, publisher, year, edition, pages
Informa Healthcare , 2013. Vol. 47, no 1, 28-35 p.
Keyword [en]
acute coronary syndrome, coronary artery bypass grafting, natriuretic peptides
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-88661DOI: 10.3109/14017431.2012.731518ISI: 000313678500004OAI: oai:DiVA.org:liu-88661DiVA: diva2:605499
Note

Funding Agencies|Swedish Heart-Lung Foundation|20030595|Capio Research Foundation|2005-10212006-1203|Linkoping University||Ostergotlands Lans Landsting||

Available from: 2013-02-14 Created: 2013-02-14 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Markers of hemodynamic state and heart failure as predictors for outcome in cardiac surgery: with special reference to mixed venous oxygen saturation and natriuretic peptides
Open this publication in new window or tab >>Markers of hemodynamic state and heart failure as predictors for outcome in cardiac surgery: with special reference to mixed venous oxygen saturation and natriuretic peptides
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postoperative heart failure or low cardiac output syndrome is the major cause for morbidity and mortality in cardiac surgery. Unfortunately commonly used methods to assess hemodynamic state and heart failure are not well documented with regard to outcome. The aim for this dissertation was to study the predictive values of postoperative Mixed Venous Oxygen saturation (SvO2) and preoperative NT-proBNP for outcomes related to postoperative heart failure.

SvO2 was studied retrospectively in two cohorts of patients, one cohort operated with isolated Aortic Valve Replacement (AVR) for aortic stenosis, (n=396) and one operated with isolated Coronary Artery Bypass Grafting (CABG), (n=2755). SvO2 measured early after surgery, on admission to the intensive care unit (ICU), predicted postoperative morbidity and mortality. Our results suggest that, on admission to ICU SvO2 < 55 - 60% after AVR and SvO2 < 60% after CABG merits increased attention.

Preoperative NT-proBNP was studied in a cohort of patients with acute coronary syndrome (ACS) undergoing CABG with or without concomitant procedure. These patients (n=383) were included prospectively and evaluated with regard to mortality and severe circulatory failure postoperatively by an end-points committee blinded to NT-proBNP results. Preoperative NT-proBNP ≥ 1028 ng/L independently predicted increased risk for severe circulatory failure postoperatively in patients with ACS undergoing isolated CABG. Preoperative NT-proBNP provided additional prognostic information to EuroSCORE II in this cohort, particularly in patients at intermediate risk. Preoperative NT-proBNP appears to be markedly higher in patients having CABG with concomitant procedures than in patients undergoing isolated CABG. Further studies are warranted to identify preoperative NTproBNP risk thresholds for different heart conditions and surgery-specific cohorts.

In conclusion this dissertation shows that:

  • Postoperative SvO2 on admission to ICU is a prognostic marker for morbidity and mortality after AVR and CABG.
  • Preoperative NT-proBNP ≥ 1028 ng/L independently predicts severe circulatory failure postoperatively in patients undergoing isolated CABG and provides additional prognostic information to EuroSCORE II.
  • The high negative predictive value of the identified cutoff levels for preoperative NTproBNP and postoperative SvO2 could be useful for pre and postoperative decisionmaking.
Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1375
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97336 (URN)978-91-7519-541-4 (ISBN)
Public defence
2013-09-27, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
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Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2013-09-10Bibliographically approved

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Holm, JonasVánky, FarkasHakanson, ErikSvedjeholm, Rolf

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Department of Medical and Health SciencesFaculty of Health SciencesDepartment of Thoracic and Vascular SurgeryThoracic SurgeryDivision of Cardiovascular Medicine
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Scandinavian Cardiovascular Journal
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