Prognostic Implications of Preoperative N-Terminal Pro-B-Type Natriuretic Peptide Dynamics in Patients Undergoing Cardiac Surgery
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: High levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reflect poor cardiac status in heart failure patients. OBJECTIVES: This study analyzed the association of preoperative NT-proBNP dynamics with 30-day and 5-year mortality after cardiac surgery. METHODS: A consecutive cohort of 6,938 patients undergoing cardiac surgery was analyzed. The relationship between preoperative NT-proBNP levels and 30-day and 5-year mortality (median follow up time: 4.53 [2.00-5.00] years) adjusted for EuroSCORE II was explored with a Cox proportional hazards model. The dynamics of preoperative NT-proBNP levels were analyzed by comparing the values at diagnosis or assignment to surgery with the values on the day before surgery (n = 4,739). Results were validated in an external cohort from the SWEDEHEART registry (n = 3,117). RESULTS: Median preoperative NT-proBNP concentration was 552 (208-1,591) ng/L. Death within 30 days occurred in 2.1% (149/6,938) of the population. High preoperative NT-proBNP levels were associated with higher 30-day and 5-year mortality. Initial high NT-proBNP at diagnosis, with subsequent decrease in preoperative NT-proBNP below 3,000 ng/L, was associated with more favorable perioperative outcomes after adjustment for EuroSCORE II shorter stays in intensive care unit (OR: 0.60, 95% CI: 0.44-0.82), less use of ultrafiltration (OR: 0.48, 95% CI: 0.33-0.70), or extracorporeal membrane oxygenation (OR: 0.26, 95% CI: 0.12-0.57; all P < 0.001) and lower 30-day mortality (HR: 0.21, 95% CI: 0.07-0.61; P = 0.004). Five-year survival was improved in patients with decreases in preoperative NT-proBNP levels (log-rank: P < 0.001, HR: 0.44, 95% CI: 0.30-0.65). CONCLUSIONS: Reductions in NT-proBNP levels before surgery were associated with lower 30-day and 5-year mortality after cardiac surgery. Patients with high NT-proBNP concentrations may benefit from preoperative optimization to lower NT-proBNP.
Source: JACC Advances
Authors: Leo Pölzl, Ronja Lohmann, Fabian Theurl, Christian Puelacher, Philipp Sterzinger, Jonas Eder, Christian Sutter, Maria Ioannou-Nikolaidou, Felix Nägele, Jakob Hirsch, Michael Graber, Clemens Engler, Vanessa Heim, Sophia Schmidt, Juliane Kilo, Sebastian J. Reinstadler, Hanno Ulmer, Samuel Heuts, Tomas Gudbjartsson, Anders Jeppsson, Emely Ögren, Andrea Griesmacher, Michael Grimm, Axel Bauer, Nikolaos Bonaros, Gerhard Pölzl, Johannes Holfeld, Can Gollmann-Tepeköylü
Institutions: Innsbruck Medical University, Universität Innsbruck, University of Warwick, Maastricht University Medical Centre, University of Iceland, National University Hospital of Iceland, Sahlgrenska University Hospital, University of Gothenburg, Deutsches Herzzentrum München, Technical University of Munich
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W4413636942