B-Type Natriuretic Peptide as a Predictor of Short-Term Mortality in On-Pump Coronary Artery Bypass Grafting.

Jamil Alli Murad,Marcelo José Ferreira Soares,Moacir Fernandes De Godoy,Cristiane Carvalho Singulane,Márcio Pimentel Fernandes,Mauricio Nassau Machado,Ingrid Helen Grigolo

doi:10.21470/1678-9741-2017-0154

Jamil Alli Murad, Marcelo José Ferreira Soares + Show 5 more

Open Access

https://doi.org/10.21470/1678-9741-2017-0154

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Abstract

ObjectiveThe present study refers to a determination of the preoperative B-type natriuretic peptide is a predictor of short-term all-cause mortality in patients undergoing on-pump coronary artery bypass graft surgeries.MethodsTwo hundred and twenty-one patients undergoing on-pump coronary artery bypass graft surgeries were evaluated prospectively during a 30-day postoperative follow-up period. Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality.ResultsData analysis showed that all-cause mortality rates were equal to 9.5% in 30 days. Accuracy analysis by the receiver operating characteristic curve found an ideal cut-off value of B-type natriuretic peptide equal to 150 pg/mL in relation to mortality (AUC=0.82, 95% CI=0.71-0.87, P<0.001). Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, HR=3.99, 95% CI=1.14-13.98) was an independent predictor of all-cause mortality in a 30-day follow-up period.ConclusionPreoperative serum B-type natriuretic peptide concentration is an independent predictor of short-term all-cause mortality in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Highlights

Since its introduction in the 1960s, coronary artery bypass grafting (CABG) is the most studied surgical procedure in medical history and rapidly as the standard treatment for patients with extensive coronary artery disease[1].In the last decades, there has been a significant decline in short-term mortality for this procedure
Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality
Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, hazard ratio (HR)=3.99, 95% CI=1.1413.98) was an independent predictor of all-cause mortality in a 30-day follow-up period

Summary

Introduction

Since its introduction in the 1960s, coronary artery bypass grafting (CABG) is the most studied surgical procedure in medical history and rapidly as the standard treatment for patients with extensive coronary artery disease[1].In the last decades, there has been a significant decline in short-term mortality for this procedure. This work can be attributed to an improvement in the surgical technique combined with the significant progress in perioperative care, as well as the development and diffusion of databases that provide a better definition and understanding of variables that impact on mortality after CABG[2,3,4,5,6]. This stabilization of mortality is a challenge for the discovery of new variables to predict mortality in order to further improve the care related to this procedure. Due to its close correlation with ventricular parietal stress and clinical and hemodynamic variables that determine a higher cardiovascular risk, B-type natriuretic peptide (BNP) has been investigated as a new prognostic tool to predict mortality in cardiac surgery[7,8,9].

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