open access

Vol 69, No 11 (2011)
Original articles
Published online: 2011-11-17
Submitted: 2012-12-28
Get Citation

Diagnostic accuracy of pre−operative NT−proBNP level in predicting short−term outcomes in coronary surgery: a pilot study

Łukasz J. Krzych, Dariusz Szurlej, Tadeusz Kołodziej, Leszek Machej, Andrzej Węglarzy, Andrzej Błach, Mirosław Wilczyński, Stanisław Woś, Andrzej Bochenek
Kardiol Pol 2011;69(11):1121-1127.

open access

Vol 69, No 11 (2011)
Original articles
Published online: 2011-11-17
Submitted: 2012-12-28

Abstract

Background: B-type natriuretic peptides (BNP) are acknowledged markers of acute and chronic heart failure. Insufficient data exist, however, regarding their diagnostic usefulness in cardiac surgery, particularly in coronary patients.
Aim: To assess diagnostic accuracy of preoperative value of NT-proBNP level as a predictor of short-term postoperative complications in subjects undergoing coronary artery bypass grafting (CABG).
Methods: This pilot study included 100 consecutive patients scheduled for elective CABG, including 24 females and 76 males (mean age 65.9 ± 9.1 years). Exclusion criteria were: significant valvular disorders, off-pump procedure, renal failure (GFR < 60 mL/min/1.73 m2), low ejection fraction (< 30%), intra-aortic balloon pump counterpulsation (IABP), use of inotropic agents, atrial fibrillation (AF), and implanted pacemaker or defibrillator. The NT-proBNP level was measured on the day of the surgery before induction of anaesthesia. We investigated short-term postoperative complications, defined as those occurring within 30 days or before hospital discharge.
Results: Median NT-proBNP concentration was 526.0 pg/mL (IQR 156.0–1150.0). None of patients died postoperatively. Excessive drainage (> 850 mL) was found in 13 (13%) patients and 22 (22%) subjects required transfusions. Prolonged mechanical ventilation (> 12 h) was necessary in 15 (15%) patients and respiratory failure occurred in 2 (2%) of them. Postoperative AF was present in 34 (34%) subjects. Perioperative myocardial infarction was diagnosed in 2 (2%) persons. Low cardiac output was present in 9 (9%) patients. Haemodynamic support with the use of IABP was necessary in 7 (7%) patients and inotropic drugs were used in 61 (61%) subjects. Stroke or delirium was diagnosed in 1 (1%) subject. The NT-proBNP level correlated with the operative risk estimated by logistic and additive EuroSCORE: r = 0.558 (95% CI 0.406–0.680; p < 0.001) and r = 0.551 (95% CI 0.397–0.674; p < 0.001), respectively. The NT-proBNP level correlated significantly with the length of Intensive Care Unit (ICU) stay and hospital stay: r = 0.412 (95% CI 0.238–0.566; p < 0.001) and r = 0.547 (95% CI 0.393–0.672; p < 0.001), respectively. The NT-proBNP level was a predictor of postoperative prolonged mechanical ventilation, respiratory failure, AF, IABP use, inotropic support and postoperative platelet transfusions (p < 0.05 for all). However, good or very good diagnostic accuracy was found only in relation to mechanical ventilation (AUROC = 0.854), respiratory insufficiency (AUROC = 0.867), IABP use (AUROC = 0.889), and milrinone use (AUROC = 0.929).
Conclusions: Preoperative assessment of NT-proBNP level in CABG patients could be a valuable diagnostic method for predicting several postoperative complications, especially pulmonary outcomes and requirement for haemodynamic support, and it correlated with the length of ICU stay and hospital stay.
Kardiol Pol 2011; 69, 11: 1121–1127

Abstract

Background: B-type natriuretic peptides (BNP) are acknowledged markers of acute and chronic heart failure. Insufficient data exist, however, regarding their diagnostic usefulness in cardiac surgery, particularly in coronary patients.
Aim: To assess diagnostic accuracy of preoperative value of NT-proBNP level as a predictor of short-term postoperative complications in subjects undergoing coronary artery bypass grafting (CABG).
Methods: This pilot study included 100 consecutive patients scheduled for elective CABG, including 24 females and 76 males (mean age 65.9 ± 9.1 years). Exclusion criteria were: significant valvular disorders, off-pump procedure, renal failure (GFR < 60 mL/min/1.73 m2), low ejection fraction (< 30%), intra-aortic balloon pump counterpulsation (IABP), use of inotropic agents, atrial fibrillation (AF), and implanted pacemaker or defibrillator. The NT-proBNP level was measured on the day of the surgery before induction of anaesthesia. We investigated short-term postoperative complications, defined as those occurring within 30 days or before hospital discharge.
Results: Median NT-proBNP concentration was 526.0 pg/mL (IQR 156.0–1150.0). None of patients died postoperatively. Excessive drainage (> 850 mL) was found in 13 (13%) patients and 22 (22%) subjects required transfusions. Prolonged mechanical ventilation (> 12 h) was necessary in 15 (15%) patients and respiratory failure occurred in 2 (2%) of them. Postoperative AF was present in 34 (34%) subjects. Perioperative myocardial infarction was diagnosed in 2 (2%) persons. Low cardiac output was present in 9 (9%) patients. Haemodynamic support with the use of IABP was necessary in 7 (7%) patients and inotropic drugs were used in 61 (61%) subjects. Stroke or delirium was diagnosed in 1 (1%) subject. The NT-proBNP level correlated with the operative risk estimated by logistic and additive EuroSCORE: r = 0.558 (95% CI 0.406–0.680; p < 0.001) and r = 0.551 (95% CI 0.397–0.674; p < 0.001), respectively. The NT-proBNP level correlated significantly with the length of Intensive Care Unit (ICU) stay and hospital stay: r = 0.412 (95% CI 0.238–0.566; p < 0.001) and r = 0.547 (95% CI 0.393–0.672; p < 0.001), respectively. The NT-proBNP level was a predictor of postoperative prolonged mechanical ventilation, respiratory failure, AF, IABP use, inotropic support and postoperative platelet transfusions (p < 0.05 for all). However, good or very good diagnostic accuracy was found only in relation to mechanical ventilation (AUROC = 0.854), respiratory insufficiency (AUROC = 0.867), IABP use (AUROC = 0.889), and milrinone use (AUROC = 0.929).
Conclusions: Preoperative assessment of NT-proBNP level in CABG patients could be a valuable diagnostic method for predicting several postoperative complications, especially pulmonary outcomes and requirement for haemodynamic support, and it correlated with the length of ICU stay and hospital stay.
Kardiol Pol 2011; 69, 11: 1121–1127
Get Citation

Keywords

coronary artery bypass grafting; NT-proBNP; diagnostic accuracy; postoperative complications

About this article
Title

Diagnostic accuracy of pre−operative NT−proBNP level in predicting short−term outcomes in coronary surgery: a pilot study

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 11 (2011)

Pages

1121-1127

Published online

2011-11-17

Bibliographic record

Kardiol Pol 2011;69(11):1121-1127.

Keywords

coronary artery bypass grafting
NT-proBNP
diagnostic accuracy
postoperative complications

Authors

Łukasz J. Krzych
Dariusz Szurlej
Tadeusz Kołodziej
Leszek Machej
Andrzej Węglarzy
Andrzej Błach
Mirosław Wilczyński
Stanisław Woś
Andrzej Bochenek

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl