title: Differential release kinetics of cardiac biomarkers in off-pump coronary bypass.
abstract: BACKGROUND
  Differential release kinetics of the cardiac biomarkers (B-type natriuretic peptide, troponin I, and creatine kinase-MB) following off-pump coronary artery bypass are not well characterized.
  
  
  METHODS
  Biomarker levels were assessed at 6, 24, 48 h, and 1 month preoperatively, in 80 patients who underwent off-pump coronary artery bypass.
  
  
  RESULTS
  All biomarkers increased within 6 h of surgery. Peak B-type natriuretic peptide levels occurred at 24-48 h in 96% of patients, but only two-thirds had peak troponin I and creatine kinase-MB levels at this time, reflecting different release patterns. Levels of all biomarkers declined within 48 h, but 42% of patients still had B-type natriuretic peptide >100 pg·mL(-1) at 1 month. Those with baseline B-type natriuretic peptide > 100 pg·mL(-1) had a lower left ventricular ejection fraction (43.6% vs. 55.6%, p < 0.01) and longer inotropic (43.8 vs. 31.4 h, p = 0.03) and ventilator support (34 vs. 25.5 h, p = 0.04) than those with lower levels. B-type natriuretic peptide levels correlated positively with angiographic Syntax score (p = 0.02) and negatively with left ventricular ejection fraction (p < 0.001). Only baseline B-type natriuretic peptide predicted the durations of inotropic support (p = 0.01) and ventilation (p = 0.02). Postoperative B-type natriuretic peptide at 6, 24, and 48 h and delta B-type natriuretic peptide were significant predictors of mean ventilation time.
  
  
  CONCLUSIONS
  Even in patients undergoing off-pump surgery, there is significant natriuretic peptide and myocardial enzyme release. Only B-type natriuretic peptide levels had an association with postoperative variables.
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Satyajit
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India akapoor65@gmail.com.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Cardiovascular Surgery, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Surendra Kumar
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Department of Cardiovascular Surgery, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Pande
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Rai
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Satyendra
authors.initials: S
authors.lastname: Tewari
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Cardiovascular Surgery, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Gauranga
authors.initials: G
authors.lastname: Majumdar
authors.affiliation: Department of Cardiovascular Surgery, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Bipin
authors.initials: B
authors.lastname: Chandra
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Goel
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D007194:India; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form
keywords: Biological markers; brain; coronary artery bypass; natriuretic peptide; off-pump; prognosis; troponin I