Elevated B-Type Natriuretic Peptide Is Associated With Increased In-Hospital Mortality or Cardiac Arrest in Patients Undergoing Implantable Cardioverter-Defibrillator Implantation

Study Questions:

Is elevated B-type natriuretic peptide (BNP) level associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing implantable cardioverter-defibrillator (ICD) implantation?

Methods:

From the National Cardiovascular Data Registry ICD Registry, the authors identified 53,198 patients who received ICD implants and underwent preoperative BNP measurement from 2006 to 2008. The patients were categorized into four groups by BNP levels (<100, 100 to <300, 300 to <1000, and ≥1000 pg/ml). Complication rates were compared among groups, and odds ratios for in-hospital mortality or cardiac arrest were estimated by multiple hierarchical logistic regressions.

Results:

There were 2,952 complications reported, including 510 in-hospital deaths and 365 cardiac arrests. The rate of in-hospital mortality or cardiac arrest significantly increased with elevated BNP level (p < 0.001). The adjusted odds ratios of in-hospital mortality or cardiac arrest were statistically significant in all three higher BNP groups [odds ratio (95% confidence interval), 1.99 (1.17-3.39), 2.49 (1.50-4.13), and 4.25 (2.57-7.06) in the second, third, and fourth groups using <100 as reference]. Among subgroups, the association was more significant in men, patients with renal dysfunction, and patients undergoing biventricular ICD implantation.

Conclusions:

The authors concluded that elevated BNP level was significantly associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implant.

Perspective:

This study suggests that elevated BNP measured preoperatively is strongly associated with an increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implantation, particularly in males, patients with renal dysfunction, and patients undergoing CRT-D implantation. The analysis expands our knowledge regarding risk factors for serious periprocedural complications associated with ICD implantation. One could speculate that a more aggressive attempt to reduce a patient’s BNP level before implantation could significantly increase the safety of the procedure, but this strategy must be prospectively tested before clinical adoption.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Hospital Mortality, Biological Markers, Risk Factors, Heart Arrest, Defibrillators, Implantable, Natriuretic Peptide, Brain


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