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Results of low-dose carperitide infusion in high-risk patients undergoing coronary artery bypass grafting
Akira Sezai1, Kin-ichi Nakata, Mitsuru Iida
1Department of Cardiovascular Surgery, Ninon University School of Medicine, Tokyo, Japan. asezai.med@gmail.com
Insights
Carperitide (hANP) significantly reduced major adverse cardiovascular and cerebrovascular events (MACCE) and the need for hemodialysis in high-risk patients undergoing coronary artery bypass grafting (CABG). This suggests a cardiorenal protective effect in the early postoperative period.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Investigated the efficacy of human atrial natriuretic peptide (hANP, carperitide) in high-risk patients undergoing coronary artery bypass grafting (CABG).
- High-risk patients were defined by a European System for Cardiac Operative Risk Evaluation score above 6.
Purpose of the Study:
- To evaluate the cardiorenal protective effects of carperitide in high-risk CABG patients.
- To assess the impact of carperitide on major adverse cardiovascular and cerebrovascular events (MACCE) and renal function.
Main Methods:
- A randomized controlled trial involving 367 high-risk patients undergoing CABG.
- Primary endpoint: MACCE. Secondary endpoints included postoperative death, MACCE plus hemodialysis, and serum creatinine and brain natriuretic peptide (BNP) levels.
- Logistic regression analysis identified factors associated with early death and MACCE.
Main Results:
- The MACCE-free rate was significantly higher in the carperitide group (p < 0.0001).
- No patients in the carperitide group required hemodialysis postoperatively, compared to 7 in the placebo group (p = 0.0147).
- Serum creatinine and BNP levels were significantly lower in the carperitide group at 1-year follow-up. MACCE were associated with older age, chronic kidney disease, hemodialysis, left ventricular dysfunction, and nonuse of carperitide.
Conclusions:
- Carperitide demonstrated a cardiorenal protective effect, preventing postoperative MACCE and the need for hemodialysis in high-risk CABG patients.
- Perioperative low-dose carperitide infusion may be beneficial for high-risk patients undergoing on-pump CABG.
Background:
This study investigated the efficacy of human atrial natriuretic peptide (hANP, carperitide) for high-risk patients undergoing coronary artery bypass grafting (CABG).
Methods:
This was a randomized controlled trial of 367 high-risk patients (European System for Cardiac Operative Risk Evaluation above 6) undergoing CABG. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were (1) postoperative death, (2) MACCE + hemodialysis, and (3) serum creatinine and brain natriuretic peptide (BNP) levels. Logistic regression analysis was conducted to identify preoperative and perioperative factors related to early death and MACCE.
Results:
There was no significant difference of survival between the hANP and placebo groups (p = 0.1651), but the MACCE-free rate was significantly higher in the hANP group than in the placebo group (p < 0.0001). No patient from the hANP group started hemodialysis after operation, but 7 patients did in the placebo group, and the dialysis rate was significantly lower in the hANP group (p = 0.0147). Serum creatinine and BNP were also significantly lower in the hANP group at 1 year postoperatively. MACCE were strongly associated with age 75 years or older, chronic kidney disease, hemodialysis, left ventricular dysfunction, and nonuse of carperitide.
Conclusions:
In the early postoperative period, carperitide has a cardiorenal protective effect that prevents postoperative MACCE and hemodialysis. Perioperative low-dose carperitide infusion may be useful in high-risk patients undergoing on-pump CABG.
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