title: Pre-operative N-terminal pro-brain natriuretic peptide predicts outcome in type A aortic dissection.
abstract: BACKGROUND
  Acute Stanford type A aortic dissection (AAD) is associated with substantial perioperative mortality and morbidity.
  
  
  OBJECTIVE
  N-terminal pro-brain natriuretic peptide (NT-proBNP) is a prognostic biomarker of outcome in cardiovascular disease. Its predictive power in patients undergoing emergency surgery for acute type A aortic dissection is yet unknown.
  
  
  METHODS
  We prospectively measured pre-operative NT-proBNP in 104 patients (39 female, 35%; median age 61 years) undergoing emergency surgery for AAD during a 6-year study period. European System for Cardiac Operative Risk Evaluation risk scores were recorded and patients were followed for 30-day mortality and major adverse events (MAEs) as defined by the need for rethoracotomy, occurrence of postoperative heart failure, neurologic deficit, lung failure, renal failure, or sepsis.
  
  
  RESULTS
  Median logistic European System for Cardiac Operative Risk Evaluation in the cohort was 12 (interquartile range 7 to 19). During the first 30 days, 23 patients (22%) died, and 53 patients (51%) experienced MAEs. Median (interquartile range) NT-proBNP levels in survivors versus nonsurvivors were 328 pg/ml (157 to 569) versus 2,240 pg/ml (515 to 4,734; p < 0.001), and in patients without versus with MAEs, 227 pg/ml (107 to 328) and 719 pg/ml (442 to 2,287; p < 0.001), respectively. Adjusted odds ratios for increasing tertiles of NT-proBNP compared with the lowest tertile were 0.98 (95% confidence interval [CI] 0.18 to 5.33; p = 0.98) and 11.67 (95% CI 2.61 to 52.09; p = 0.001) for 30-day mortality and 9.07 (95% CI 2.58 to 31.83; p = 0.001) and 50.21 (95% CI 10.85 to 232.45; p < 0.001) for MAEs, respectively, indicating a significant association between pre-operative NT-proBNP levels and outcome.
  
  
  CONCLUSIONS
  Pre-operative NT-proBNP predicts outcome in patients undergoing surgery of AAD.
authors.affiliation: Department of Emergency Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
authors.forename: Karin
authors.initials: K
authors.lastname: Janata
authors.forename: Markus
authors.initials: M
authors.lastname: Thalmann
authors.forename: Marek P
authors.initials: MP
authors.lastname: Ehrlich
authors.forename: Georg
authors.initials: G
authors.lastname: Endler
authors.forename: Anton
authors.initials: A
authors.lastname: Laggner
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000097:blood* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000097:blood* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain