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  • Title: Preoperative brain natriuretic peptide predicts late mortality and functional class but not hospital readmission after cardiac surgery.
    Author: Vikholm P, Schiller P, Hellgren L.
    Journal: J Cardiothorac Vasc Anesth; 2014 Jun; 28(3):520-7. PubMed ID: 24731743.
    Abstract:
    OBJECTIVES: N-terminal brain natriuretic peptide (NT-proBNP) is an established biomarker of heart failure and has been found to predict mortality and morbidity after cardiac surgery. The aim of this study was to investigate whether preoperative NT-proBNP can predict postoperative New York Heart Association (NYHA) functional class and hospital readmission in addition to morbidity and mortality. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: All patients undergoing aortic valve replacement for aortic stenosis and coronary artery bypass grafting from January to December 2008 (n = 390). MEASUREMENTS AND MAIN RESULTS: Preoperative NT-proBNP was recorded prospectively. Five-year mortality was obtained through national registries. Postoperative functional class, morbidity, and hospital readmission were obtained through telephone interviews. Patients were divided into quartiles based on preoperative NT-proBNP; the medians of each quartile were 103 ng/L, 291 ng/L, 825 ng/L and 2,375 ng/L. Increased preoperative NT-proBNP was associated with reduced postoperative functional class. In the first quartile, 7% (7/97) were in NYHA functional class III-IV compared to 26% (25/97) in the fourth quartile (p<0.01). Increased preoperative NT-proBNP was also associated with reduced long-term survival (p<0.01). The covariate adjusted hazard ratio for mortality in the fourth quartile was 2.9 (1.61-5.08; p<0.01) compared to the other quartiles. No association was found between preoperative NT-proBNP and postoperative hospital readmission. CONCLUSIONS: Increased preoperative NT-proBNP is associated with reduced long-term survival and functional class but not hospital readmission post-cardiac surgery. Thus, NT-proBNP might have additive value to established risk factors in the preoperative assessment of patients undergoing cardiac surgery.
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