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

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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.

Abbreviations and Acronyms

BNP
B-type natriuretic peptide
CABG
coronary artery bypass grafting
CHF
congestive heart failure
CI
confidence interval
CPB
cardiopulmonary bypass
cTnI
cardiac troponin I
IABP
intra-aortic balloon pump
LVEF
left ventricular ejection fraction
POD
postoperative day
VAD
ventricular assist device

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Supported by Siemens Medical Solutions Diagnostics, Tarrytown, NY (grant funding and reagents for cTnI and BNP assays); University of Texas, Houston General Clinical Research Center Core Facilities Grant (NCRR M01 02558 providing pilot funding to A.A.F. and C.D.C); Society of Cardiovascular Anesthesiologists Research Starter Grant (A.A.F.); and National Institutes of Health grant K23-HL068774 (S.C.B.).