B-type Natriuretic Peptide Predicts Morbidity and Long-Term Mortality in Coronary Artery Bypass Grafting and Valve Surgery
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Published on: March 27, 2018
Kendal M Endicott1, Richard L Amdur, Michael D Greenberg
1From the *Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC USA; †Division of Cardiothoracic Surgery, The George Washington University, Washington, DC USA; and ‡Division of Cardiology, Veterans Affairs Medical Center, Washington, DC USA.
Insights
Elevated B-type natriuretic peptide (BNP) levels predict complications and mortality after heart surgery. Monitoring BNP aids in managing heart failure and improving long-term survival for cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Coronary artery bypass grafting (CABG) and valve surgery are common cardiac procedures.
- Predicting morbidity and mortality after these surgeries is crucial for patient outcomes.
Purpose of the Study:
- To evaluate B-type natriuretic peptide (BNP) as a predictor of morbidity, mortality, and long-term survival in patients undergoing CABG and/or valve surgery.
Main Methods:
- Retrospective review of 432 patients undergoing CABG and/or valve surgery (2012-2015).
- BNP levels were analyzed in quartiles (Q1-Q4).
- Mortality data were tracked for up to 3.4 years post-surgery.
Main Results:
- BNP quartile independently predicted complications; highest quartile (Q4) showed increased risk (aOR, 3.81).
- BNP quartile correlated with time to death (log-rank χ, 8.30; P = 0.04), particularly at 9 months.
- Cox regression showed increased mortality risk in Q2 (HR, 3.73) and Q4 (HR, 4.33).
- The highest risk group had a 30-fold higher relative risk of complications compared to the lowest risk group.
Conclusions:
- BNP levels are an independent predictor of morbidity following CABG and/or valve surgery.
- Elevated BNP levels correlate with increased mortality risk, emphasizing the need for follow-up.
- Sustained follow-up and heart failure management are vital for improving survival in cardiac surgery patients with elevated BNP.
Objective:
To assess whether B-type natriuretic peptide (BNP) levels are a useful predictor of morbidity and mortality as well as long-term survival in patients after coronary artery bypass grafting (CABG) and valve surgery.
Methods:
A retrospective review of CABG and/or valve surgery patients from 2012 to 2015 at a single center was conducted. A total of 432 patients were identified (CABG, 295 patients; valve, 82 patients; and CABG + valve, 55 patients). B-type natriuretic peptide levels were divided into quartiles (Q1-Q4). Mortality data were available for up to 3.4 years after surgery.
Results:
B-type natriuretic peptide quartile was independently associated with any complication on multivariate analysis. Patients in Q4 were at highest risk (adjusted odds ratio, 3.81; P = 0.047 vs Q1). There was a significant association between BNP quartile and time to death (log-rank χ, 8.30; P = 0.04) with greatest association 9 months postoperatively. B-type natriuretic peptide quartile was significantly associated with time to death in Cox regression in Q2 (hazard ratio [HR], 3.73 (1.04-13.44); P = 0.044) and Q4 (HR, 4.33 (1.14-16.44); P = 0.031). Q3 also had a higher risk of death (HR, 3.5 vs Q1); however, this was only significant at a trend level (P = 0.06). Using a risk model generated from logistic regression, we determined that the highest risk group had relative risk of complications 30 times higher than the lowest risk group.
Conclusions:
B-type natriuretic peptide levels are an independent predictor of morbidity after CABG and/or valve surgery regardless of type of procedure or on/off bypass usage. B-type natriuretic peptide levels also correlate with time to death, highlighting the need for sustained follow-up and heart failure management to improve survival in patients with elevated BNP levels presenting for all cardiac surgery.
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