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J Thorac Cardiovasc Surg 2008;136:452-461
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting

^a Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
^b Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
^c Department of Pathology, Division of Clinical Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
^d Baylor College of Medicine Division of Cardiovascular Anesthesia at the Texas Heart Institute, Saint Luke's Episcopal Hospital, Houston, Tex
^e Department of Biostatistics, Harvard School of Public Health, Boston, Mass

Received for publication August 15, 2007; revisions received December 10, 2007; accepted for publication December 27, 2007.

^_* Address for reprints: Amanda A. Fox, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. (Email: afox{at}partners.org).

Objective: Elevated B-type natriuretic peptide is associated with increased morbidity and mortality in ambulatory patients with congestive heart failure or acute coronary syndromes. Its utility in predicting adverse cardiac surgical outcomes is less certain. We hypothesized that preoperative plasma B-type natriuretic peptide would independently predict in-hospital postoperative ventricular dysfunction, hospital stay, and up to 5-year mortality after primary coronary artery bypass grafting.

Methods: This is a prospective, longitudinal study of 1023 patients at two institutions undergoing primary coronary artery bypass grafting with cardiopulmonary bypass. Ventricular dysfunction was defined as requirement for at least two inotropes or new intra-aortic balloon pump or ventricular assist device support after coronary artery bypass grafting. Multivariable analyses assessed independent roles of preoperative B-type natriuretic peptide in predicting postoperative ventricular dysfunction, hospital stay, and 5-year all-cause mortality.

Results: Preoperative plasma B-type natriuretic peptide concentration predicted ventricular dysfunction, hospital stay, and mortality in univariate and multivariable analyses. Logistic regression demonstrated preoperative B-type natriuretic peptide to independently predict ventricular dysfunction (odds ratio 1.92, 95% confidence interval 1.12–3.29, P = .018), after adjustment for preoperative left ventricular ejection fraction, congestive heart failure severity, and other clinical predictors. Multivariable Cox proportional hazards models showed preoperative B-type natriuretic peptide to independently predict hospital stay (hazard ratio 1.42, 95% confidence interval 1.18–1.72, P = .0002) and mortality (hazard ratio 1.89, 95% confidence interval 1.08–3.33, P = .026).

Conclusion: Preoperative plasma B-type natriuretic peptide independently predicted in-hospital ventricular dysfunction, hospital stay, and up to 5-year all-cause mortality after primary coronary artery bypass grafting.