title: Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients.
abstract: BACKGROUND
  The N-terminal fragment of pro-brain type natriuretic peptide (NT-proBNP) is an established biomarker for cardiac failure.
  
  
  OBJECTIVE
  To determine the influence of preoperative serum NT-proBNP on postoperative outcome and mid-term survival in patients undergoing coronary artery bypass grafting (CABG).
  
  
  METHODS
  In 819 patients undergoing isolated CABG surgery preoperative serum NT-proBNP levels were measured. NT-proBNP was correlated with various postoperative outcome parameters and survival rate after a median follow-up time of 18 (0.5-44) months. Risk factors of mortality were identified using χ², Mann-Whitney test, and Cox regression.
  
  
  RESULTS
  NT-proBNP levels > 430 ng/ml and > 502 ng/ml predicted hospital and overall mortality (p < 0.05), with an incidence of 1.6% and 4%, respectively. Kaplan-Meier analysis revealed decreased survival rates in patients with NT-proBNP > 502 ng/ml (p = 0.001). Age, preoperative serum creatinine, diabetes, chronic obstructive pulmonary disease, low left ventricular ejection fraction and BNP levels >502 ng/ml were isolated as risk factors for overall mortality. Multivariate Cox regression analysis, including the known factors influencing NT-proBNP levels, identified NT-proBNP as an independent risk factor for mortality (OR = 3.079 (CI = 1.149-8.247), p = 0.025). Preoperative NT-proBNP levels >502 ng/ml were associated with increased ventilation time (p = 0.005), longer intensive care unit stay (p=0.001), higher incidence of postoperative hemofiltration (p = 0.001), use of intra-aortic balloon pump (p < 0.001), and postoperative atrial fibrillation (p = 0.031)
  
  
  CONCLUSIONS
  Preoperative NT-proBNP levels > 502 ng/ml predict mid-term mortality after isolated CABG and are associated with significantly higher hospital mortality and perioperative complications.
authors.affiliation: Innsbruck Medical University, Innsbruck, Austria. Thomas.schachner@i-med.ac.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.forename: Hannes
authors.initials: H
authors.lastname: Fetz
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Alfred
authors.initials: A
authors.lastname: Kocher
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality; D011184:Postoperative Period; D011300:Preoperative Care; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain