title: Increased perioperative b-type natriuretic peptide associates with heart failure hospitalization or heart failure death after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Heart failure (HF) is a leading cause of hospitalization and mortality. Plasma B-type natriuretic peptide (BNP) is an established diagnostic and prognostic ambulatory HF biomarker. We hypothesized that increased perioperative BNP independently associates with HF hospitalization or HF death up to 5 yr after coronary artery bypass graft surgery.
  
  
  METHODS
  The authors conducted a two-institution, prospective, observational study of 1,025 subjects (mean age = 64 ± 10 yr SD) undergoing isolated primary coronary artery bypass graft surgery with cardiopulmonary bypass. Plasma BNP was measured preoperatively and on postoperative days 1-5. The study outcome was hospitalization or death from HF, with HF events confirmed by reviewing hospital and death records. Cox proportional hazards analyses were performed with multivariable adjustments for clinical risk factors. Preoperative and peak postoperative BNP were added to the multivariable clinical model in order to assess additional predictive benefit.
  
  
  RESULTS
  One hundred five subjects experienced an HF event (median time to first event = 1.1 yr). Median follow-up for subjects who did not have an HF event = 4.2 yr. When individually added to the multivariable clinical model, higher preoperative and peak postoperative BNP concentrations each, independently associated with the HF outcome (log10 preoperative BNP hazard ratio = 1.93; 95% CI, 1.30-2.88; P = 0.001; log10 peak postoperative BNP hazard ratio = 3.38; 95% CI, 1.45-7.65; P = 0.003).
  
  
  CONCLUSIONS
  Increased perioperative BNP concentrations independently associate with HF hospitalization or HF death during the 5 yr after primary coronary artery bypass graft surgery. Clinical trials may be warranted to assess whether medical management focused on reducing preoperative and longitudinal postoperative BNP concentrations associates with decreased HF after coronary artery bypass graft surgery.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. afox@partners.org
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Fox
authors.forename: Luigino
authors.initials: L
authors.lastname: Nascimben
authors.forename: Simon C
authors.initials: SC
authors.lastname: Body
authors.forename: Charles D
authors.initials: CD
authors.lastname: Collard
authors.forename: Aya A
authors.initials: AA
authors.lastname: Mitani
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Liu
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D015415:Biomarkers; D001900:Boston / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D059035:Perioperative Period / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain