N-Terminal Pro-B-Type Natriuretic Peptide as a Predictor of Adverse Outcomes After Off-Pump Coronary Artery Bypass Surgery: A Prospective Study
N-terminal pro-B-type natriuretic Peptide as a Predictor after Offpump Coronary Artery Bypass Surgery
DOI:
https://doi.org/10.1532/hsf.4143Keywords:
NT-proBNP, off-pump CABG, adverse postoperative outcomes, in-hospital mortalityAbstract
Background: The strength of association between preoperative natriuretic peptide levels and adverse outcomes after cardiac surgery recently has been studied in different research, but results still are diversely variable.
Methods: Sixty-five consecutive patients undergoing elective off-pump coronary artery bypass grafting prospectively were recruited. Preoperative levels of NTproBNP were measured in venous blood samples collected before induction of anesthesia.
Results: The average age was 57.62 ± 7.21. Of the patients, 86.15% were male. Euro-scoreII averaged 1.76 ± 0.34. The mean preoperative NTproBNP levels were 312.41 ± 329.93 pg/mL. Only two patients died (3%). Three patients required prolonged mechanical ventilation (4.6%). Four patients (6%) suffered from new onset postoperative AF. Five patients (7.6%) had low cardiac output, of which three needed IABP, and four patients (6%) had postoperative myocardial infarction. The mean ICU stay was 3.37 ± 0.84 days, and the mean hospital stay was 6.38 ± 1.3 days. There were no significant differences in preoperative NTproBNP levels in patients who had or didn’t have any of the postoperative complications or in-hospital mortality (P > .05).
Conclusion: Our study showed no significant correlation between preoperative NTproBNP levels and postoperative low cardiac output, atrial fibrillation, postoperative myocardial infarction, length of ICU stay, prolonged mechanical ventilation, length of hospital stay as well as in-hospital mortality following elective off-pump CABG. Therefore, more prospective specific studies are needed to delineate the role of preoperative natriuretic peptides as significant predictors of poor outcomes after CABG surgery.
References
Akhmedova IA, Kudaiberdiev TZ, Abibillaev DA, et al. 2020. Relationship of preoperative NT-pro-BNP with clinical, perioperative and prognostic markers in cardiacsurgery: Preliminary study results. Heart Vessels Transplant. 4:99-110.
Attaran S, Sherwood R, Desai J, Langworthy R, Mhandu P, John L, El-Gamel A. 2009. Brain natriuretic peptide a predictive marker in cardiac surgery. 9:662-666.
Brynildsen J, Petäjä L, Pettilä V, et al. 2018. The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients. Clinical Biochemistry. 53:65-71.
Chen TH, Lin CL, Shih JJ, et al. 2013. Plasma B-type natriuretic peptide in predicting outcomes of elective coronary artery bypass surgery. Kaohsiung Journal of Medical Sciences. 29:254-258.
Cuthbertson BH, Croal BL, Rae D, et al. 2009. N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery: a prospective cohort study. Br J Anaesth. 103:647-653.
Elíasdóttir SB, Klemenzson G, Torfason B, Valsson F. 2008. Brian natriuretic peptide is a good predictor for outcome in cardiac surgery. Acta Anaesthesiol Scan. 52:182-187.
Emdin M, Passino C, Prontera C, et al. 2004. Cardiac natriuretic hormones, neuroor-mones, thyroid hormones and cytokines in normal subjects and patients with heart failure. Clin Chem Lab Med. 42:627–636.
Fellahi JL, Daccache G, Makroum Y, Massetti M, Gérard JL, Hanouz JL. 2012. The Prognostic Value of B-Type Natriuretic Peptide After Cardiac Surgery: A Comparative Study Between Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement.Journal of Cardiothoracic and Vascular Anesthesia. 26:624-30.
Fellahi JL, Daccache G, Rubes D, Massetti M, Gérard JL, Hanouz JL. 2011. Does Preoperative B-Type Natriuretic Peptide Better Predict Adverse Outcome and Pro-longed Length of Stay Than the Standard European System for Cardiac Operative Risk Evaluation After Cardiac Surgery? J Cardiothorac Vasc Anesth. 25:256-262.
Gaggin and Januzzi. 2013. Biomarkers and diagnostics in heart failure. Biochem Bio-phys Acta. 1832:2442-245.
Gaggin and Januzzi J. 2014. Natriuretic peptides in heart failure syndrome. Clin Lab Med. 34:43-58.
Iwanaga Y, Nishi I, Furuichi S, et al. 2006. B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between sys-tolic and diastolic heart failure. Journal of American College of Cardiology. 47:742-748.
Jogia PM., Kalkoff M, Sleigh JW, et al. 2007. NTproBNP secretion and clinical end-points in cardiac surgery intensive care patients. Anaesth Intensive Care. 35:363-369.
Krzych Ł, Szurlej D, Kołodziej T. 2011. Diagnostic accuracy of preoperative NT−proBNP level in predicting short−term outcomes in coronary surgery: a pilot study. Kardiologia Polska. 69:1121–1127.
Litton E and Ho KM. 2012. The use of pre-operative brain natriuretic peptides as a predictor of adverse outcomes after cardiac surgery: a systematic review and meta-analysis. European Journal of Cardio-thoracic Surgery. 41:525-534.
Liu H, Wang C, Liu L, Zhuang Y, Yang X, Zhang Y. 2013. Perioperative application of N-terminal pro-brain natriuretic peptide in patients undergoing cardiac surgery. Journal of Cardiothoracic Surgery. 8:1-5.
Öztekin A, Memetoðlu M, Kutlu R, et al. 2017. The Predictive Value of Preoperative Serum NT-proBNP Levels for the Need for Inotropic Supportin the Postoperative Pe-riod in Patients Undergoing Coronary Artery Bypass Grafting. Cardiovasc. j 9:90-96.
Schachner T, Wiedemann D, Fetz H, Laufer G, Kocher A, Bonaros N. 2010. Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients. Clinics. 65:1239-1245.
Sindhvananda W, Bunpeth C, Chareonkulnawanun N. 2019. N-Terminal Pro-Brain NatriureticPeptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes. Int J AnestheticAnesthesiol. 6:085.
Suc G, Estagnasie P, Brusset A, Procopi N, Squara P, Nguyen LS. 2020. Effect of BNP on risk assessment in cardiac surgery patients,in addition to EuroScore II. Scientific Reports. 10:10865.
