N-terminal B-natriuretic Peptide after coronary artery bypass graft surgery.
OBJECTIVE
To investigate N-terminal amino-acid sequence of the B-natriuretic peptide (NT-proBNP) release and its prognostic characteristics after coronary artery bypass graft surgery with and without cardiopulmonary bypass.


METHODS
Observational study.


METHODS
Teaching hospital.


METHODS
One hundred eighty-four patients.


METHODS
The authors determined plasma concentrations of NT-proBNP just before anesthesia induction and 24 hours after the end of the surgery.


RESULTS
NT-proBNP concentrations (median [interquartile range]) increased from 270 (75-716) pg/mL preoperatively to 1,664 (978-3,193) pg/mL on postoperative day 1 (p < 0.001), and all postoperative values were higher than the preoperative ones. NT-proBNP concentrations at day 1 were correlated to those at day 0 (r(2) = 0.34, p < 0.001). Patients showing elevated concentration of cTnI at day 1 (>14 ng/mL) had significantly (p = 0.04) higher plasma NT-proBNP levels than patients with a low cardiac troponin I concentration. Patients with prolonged intensive care unit (ICU) stay (>4 days) showed at day 1 significantly higher (p = 0.003) plasma NT-proBNP levels than patients with ICU stay <4 days. Elevated NT-proBNP at day 1 was significantly (p = 0.001) associated with in-hospital mortality, 18,584 (11,896-29,158) pg/mL versus 1,597 (965-3,034) pg/mL in survivors.


CONCLUSIONS
The present results show, for the first time, that postoperative NT-proBNP levels are associated with in-hospital mortality and prolonged ICU stay after CABG surgery. These findings support the prognostic value of postoperative plasma levels of NT-proBNP.
Crescenzi
Giuseppe
G
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italia e Istituto Scientifico San Raffaele, Milan, Italy.
Landoni
Giovanni
G
Bignami
Elena
E
Belloni
Ilaria
I
Biselli
Camilla
C
Rosica
Concetta
C
Guarracino
Fabio
F
Marino
Giovanni
G
Zangrillo
Alberto
A
D000368:Aged; D015415:Biomarkers; D003250:Constriction; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D003422:Critical Care; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000378:metabolism*; D010446:Peptide Fragments / Q000032:analysis / Q000378:metabolism*; D011184:Postoperative Period; D012372:ROC Curve; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain