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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
Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
Örebro University Hospital. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2014. Vol. 113, no 1, p. 75-82
Keywords [en]
acute coronary syndrome, coronary artery bypass surgery, natriuretic peptides, risk assessment
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-56444DOI: 10.1093/bja/aeu088ISI: 000338598700011PubMedID: 24727704Scopus ID: 2-s2.0-84903975900OAI: oai:DiVA.org:oru-56444DiVA, id: diva2:1082398
Funder
Swedish Heart Lung Foundation, 20030595
Note

Funding Agencies:

Capio Research Foundation 2005-1021  2006-1203

Linköping University

Östergotlands Läns Landsting 

Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-06-20Bibliographically approved

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Vidlund, Mårten

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School of Health and Medical Sciences, Örebro University, SwedenÖrebro University Hospital
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