Troponin T and B-Type Natriuretic Peptide After On-Pump Cardiac Surgery

Abstract

Surgical risk stratification models, 1 including the European System for Cardiac Operative Risk Evaluation (EuroSCORE), 2,3 exclusively consider preoperative and intraoperative risk factors. Although useful for healthcare planning and for preoperative risk/benefit assessments, this view may prove fragmentary postoperatively, because it disregards perioperative myocardial ischemic events 4,5 or postoperative complications 6-8 despite their association with mortality. Therefore, there is a need for tools that allow for early postoperative risk reassessment to guide management decisions (eg, transfer to step-down units and postdischarge follow-up schedules). Editorial see p 932 Clinical Perspective on p 957Troponin T (TNT) has an established prognostic value for short-term 9-11 and midterm outcomes 12-14 after cardiac surgery. However, previous studies on the predictive value of troponin 9-11 have focused on preoperative risk factors and have not accounted for postoperative complications (eg, infections or acute kidney failure). In-hospital complications, however, may exert a relevant prognostic change by being associated with both elevated cardiac biomarkers postoperatively and midterm outcome.Several studies have described the association between preoperative natriuretic peptides and outcomes after cardiac surgery. 15,16 Evidence supporting the prognostic value of postoperative concentrations, in contrast, is scarce [17][18][19][20][21][22] and has been generated mostly in small studies 17,21,22 that are underpowered Background-The independent predictive value of troponin T (TNT) after on-pump cardiac surgery was established in several studies. However, adjustment was limited to preoperative risk factors without considering perioperative complications. Data on the prognostic value of postoperative B-type natriuretic peptide (BNP) are scarce. Our aim was to assess the independent value of TNT and BNP to predict 12-month outcome after cardiac surgery with adjustment for preoperative risk estimates and postoperative complications and to report risk stratification gains when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE) combined with postoperative biomarkers. Methods and Results-This prospective cohort study included consecutive patients undergoing on-pump cardiac surgery between 2007 and 2010. We evaluated postoperative TNT and BNP, the EuroSCORE, and postoperative complications as predictors of adverse events using Cox regression. The primary end point was death or major adverse cardiac events within 1 year after surgery. We calculated the net reclassification index of TNT and BNP in addition to the EuroSCORE. We enrolled 1559 patients, of whom 176 (11.3%) experienced an event. The adjusted hazard ratio of TNT >0.8 μg/L was 2.13 (95% confidence interval, 1.47-3.15) and of BNP >790 ng/L was 2.44 (95% confidence interval, 1.65-3.62). The net reclassification index of the addition of TNT and BNP to the EuroSCORE was 0.276 (95% confidence interval, 0.195-0.348). Conclusions-Postoper...

Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study

“…(17) In that study, post-operative BNP had additional predictive value for 1-year mortality when combined with the logistic EuroSCORE. (17) In another study that included only valvular surgery patients, pre-operative BNP levels were found to be predictive of post-operative inotrope duration (OR=5.9, 95% CI 1.2, 29.68) and ventilation time (OR= 4.7, 95% CI 1.74,17.21). (20) BNP and NT-proBNP levels reflect cardiac filling pressures.…”

“…(16) A prospective cohort including 1,559 patients undergoing on-pump cardiac surgery reported that a post-operative (day 1 and 2) BNP value >790 ng/L was associated with an adjusted HR for mortality of 2.44 (95% CI 1.65–3.62). (17) In that study, post-operative BNP had additional predictive value for 1-year mortality when combined with the logistic EuroSCORE. (17) In another study that included only valvular surgery patients, pre-operative BNP levels were found to be predictive of post-operative inotrope duration (OR=5.9, 95% CI 1.2, 29.68) and ventilation time (OR= 4.7, 95% CI 1.74,17.21).…”

“…(13–15) Higher perioperative NT-proBNP levels have been associated with post-operative AKI, independently of EuroSCORE. (16, 17) With the imminent move towards high-sensitivity cardiac troponin assays, the prognostic value of this biomarker needs to be clarified in patients undergoing cardiac surgery. (18) In a prospective multicenter cohort of adults undergoing cardiac surgery, we aimed to evaluate whether pre- and post- operative cardiac biomarkers, including high-sensitivity cardiac troponin T (hs-cTnT), are associated with the development of severe AKI within the hospital stay, 1-year and long-term mortality after cardiac surgery.…”

Combined Assessment of the Red Cell Distribution Width and B-type Natriuretic Peptide: A More Useful Prognostic Marker of Cardiovascular Mortality in Heart Failure Patients

“…Many studies have demonstrated the usefulness of the serum BNP concentration in the diagnosis of HF ( 2 - 5 ). Furthermore, several studies have reported that the serum BNP concentration has prognostic value in HF patients ( 6 - 8 ); thus, BNP is considered to be the gold standard for predicting the outcome of HF.…”

Log-transformed B-type natriuretic peptide as a prognostic predictor in patients undergoing cardiovascular surgery

“…The prognostic factors in cardiac surgery are troponin and BNP. 16,17 The survival analysis in the present study showed that lnBNP, smoking, emergency operation, and PNI were prognostic factors in patients undergoing cardiovascular surgery. Smoking and an emergency operation have been reported as risk factors for surgery 18–20 and regulated prognostic factors; these results are consistent with the findings of our study, in which they were also prognostic factors.…”