Increased plasma levels of pro-brain natriuretic peptide in patients with cardiovascular complications following off-pump coronary artery surgery

• Published in: Intensive care medicine 2004-09, Vol.30 (9), p.1799-1806
• Main Authors: KERBAUL, F, COLLART, F, GIORGI, R, ODDOZE, C, LEJEUNE, P. J, GUIDON, C, CAUS, T, BELLEZZA, M, GOUIN, F
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Calcitonin - blood; Calcitonin Gene-Related Peptide; Coronary Artery Disease - blood; Coronary Artery Disease - etiology; Coronary Vessels - surgery; Critical Care; Female; Humans; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins - blood; Peptide Fragments - blood; Postoperative Complications - blood; Postoperative Complications - etiology; Prognosis; Prospective Studies; Protein Precursors - blood; Troponin I - blood
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2299-0

To compare N-terminal pro-brain natriuretic peptide (NT-pro-BNP), procalcitonin (PCT), and troponin I (Tn I) concentrations during and after coronary artery surgery in patients with or without cardiovascular complications. Prospective, comparative study of 12 months in the cardiovascular intensive care unit in a university hospital. 60 adult patients undergoing coronary artery bypass grafting with the off-pump technique. Plasma NT-pro-BNP, PCT, and Tn I levels were measured before and immediately after the end of operation and on PODs 1, and 2 and 3. We defined complicated postoperative course as myocardial infarction, cardiogenic shock, arrhythmias, congestive heart failure, and death occurring after the fourth postoperative hour. Receiver operating characteristic (ROC) curve cutoff values were used to assess the ability of the three markers to predict future cardiac events. The area under ROC curve (AUC) using NT-pro-BNP to detect a cardiovascular complicated course was 0.780 at the preoperative time and 0.850 at the end of surgery. A preoperative NT-pro-BNP value of 397 pg/ml had a sensitivity of 76%, specificity of 67%, and accuracy of 74% for predicting a subsequent cardiovascular complication. An immediate postoperative NT-pro-BNP value of 430 pg/ml had a sensitivity of 80%, specificity of 77%, and accuracy of 76%. Patients with preoperative NT-pro-BNP levels less than 275 pg/ml had an excellent postoperative prognosis. Other two markers were less appropriate. NT-pro-BNP levels measured before and immediately after off-pump coronary artery bypass seem to be predictive of postoperative cardiac events.