Troponin T and Brain Natriuretic Peptide After On-Pump Cardiac Surgery: Prognostic Impact on 12-Month Mortality and Major Cardiac Events After Adjustment for Postoperative Complications

Aug 12, 2014
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Authors:
Lurati Buse GA, Bolliger D, Seeberger E, et al.
Citation:
Circulation 2014;Aug 6:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the independent value of troponin T (TNT) and B-type natriuretic peptide (BNP) to predict 12-month outcome after cardiac surgery?

Methods:

This prospective cohort study included consecutive patients undergoing on-pump cardiac surgery between 2007 and 2010. The investigators evaluated postoperative TNT and BNP, the EuroSCORE, and postoperative complications as predictors of adverse events using Cox regression. The primary endpoint was death or major adverse cardiac events (MACE) within 1 year after surgery. The authors calculated the net reclassification index (NRI) of TNT and BNP in addition to the EuroSCORE.

Results:

The investigators enrolled 1,559 patients, of whom 176 (11.3%) suffered an event. The adjusted hazard ratio (HR) of TNT >0.8 μg/L was 2.13 (95% confidence interval [CI], 1.47-3.15), and HR of BNP >790 ng/L was 2.44 (95% CI, 1.65-3.62). The NRI of the addition of TNT and BNP to the EuroSCORE was 0.276 (95% CI, 0.195-0.348).

Conclusions:

The authors concluded that postoperative TNT and BNP are strong predictors of 1-year events after on-pump cardiac surgery.

Perspective:

This study reports that the association between an increase in TNT concentration within the first 2 postoperative days and 1-year all-cause mortality and MACE after cardiac surgery persisted after adjustment considering preoperative as well as postoperative confounders. Furthermore, there was a significant independent association between postoperative BNP concentrations and 1-year mortality and MACE. The enhancement of the EuroSCORE, a preoperative risk stratification tool, with postoperative TNT and BNP concentrations, allowed for a better prediction of 1-year all-cause mortality and the occurrence of MACE after on-pump cardiac surgery, and may be a valuable prognostic tool.

Keywords: Heart Diseases, Postoperative Complications, Troponin T, Cardiac Surgical Procedures, Natriuretic Peptide, Brain


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