Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis

• Published in: The American journal of cardiology 2008-09, Vol.102 (6), p.749-754
• Main Authors: Pedrazzini, Giovanni Battista, MD, Masson, Serge, PhD, Latini, Roberto, MD, Klersy, Catherine, MD, MSc, Rossi, Maria Grazia, MD, Pasotti, Elena, MD, Faletra, Francesco Fulvio, MD, Siclari, Francesco, MD, Minervini, Fabrizio, MD, Moccetti, Tiziano, MD, Auricchio, Angelo, MD, PhD
• Format: Article
• Language: English
• Subjects: Accuracy; Age Factors; Aged; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Brain; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Comparative analysis; Coronary Artery Bypass; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart surgery; Heart Valve Prosthesis; Hospital Mortality; Humans; Male; Medical sciences; Mortality; Natriuretic Peptide, Brain - blood; Outcome Assessment (Health Care); Peptides; Preoperative Care; Prospective Studies; Severity of Illness Index
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.04.055

The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 ± 9 years, mean aortic gradient 51 ± 18 mm Hg, and left ventricular ejection fraction 61 ± 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p