title: EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery.
abstract: BACKGROUND
  Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.
  
  
  METHODS
  A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.
  
  
  RESULTS
  Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.
  
  
  CONCLUSIONS
  Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.
  
  
  BACKGROUND
  NCT00489827.
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Linköping University Hospital, Linköping University, SE 58185 Linköping, Sweden jonas.holm@lio.se.
authors.forename: J
authors.initials: J
authors.lastname: Holm
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, SE 701 85 Örebro, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Vidlund
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Linköping University Hospital, Linköping University, SE 58185 Linköping, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Vanky
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, SE 701 85 Örebro, Sweden.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Friberg
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Linköping University Hospital, Linköping University, SE 58185 Linköping, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Håkanson
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Linköping University Hospital, Linköping University, SE 58185 Linköping, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Walther
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, Linköping University Hospital, Linköping University, SE 58185 Linköping, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Svedjeholm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D008137:Longitudinal Studies; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000401:mortality; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76)
keywords: acute coronary syndrome; coronary artery bypass surgery; natriuretic peptides; risk assessment