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Association of N-terminal pro-brain natriuretic peptide and cardiac troponin T with in-hospital cardiac events in elderly patients undergoing coronary artery surgery

Published online by Cambridge University Press:  01 October 2008

S. Suttner ,
J. Boldt ,
K. Lang ,
K. D. Röhm ,
S. N. Piper  and
J. Mayer
S. Suttner*
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
J. Boldt
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
K. Lang
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
K. D. Röhm
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
S. N. Piper
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
J. Mayer
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
*
Correspondence to: Stefan Suttner, Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany. E-mail: suttner@gmx.de; Tel: +49 621 503 3000; Fax: +49 621 503 3024
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Summary

Background and objectives

Despite evidence of their prognostic power for non-surgical patients, the value of perioperative natriuretic peptides and cardiac troponins as markers of cardiac events is incompletely defined. This study sought to examine whether perioperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) levels could be used for the prediction of in-hospital cardiac events in elderly patients undergoing elective coronary artery bypass grafting.

Methods

Ninety-eight elderly patients (>75 yr) undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were enrolled and followed up for 12–15 months. NT-proBNP and cTnT levels were measured before induction of anaesthesia and 12, 24 and 48 h after surgery. To identify the best discriminatory level of NT-proBNP and cTnT receiver operating characteristics curves were analysed.

Results

Thirty-four patients experienced 54 in-hospital cardiac events. Patients with complications had significantly higher NT-proBNP and cTnT levels than those without complications. Receiver operating characteristics curve analysis revealed cut-off levels of 2361 pg mL−1 and 0.66 μg mL−1 for NT-proBNP and cTnT (sensitivity, specificity, positive predictive value and negative predictive value of 84.3%, 89.4%, 78.9% and 92.4%, and 93.7%, 74.2%, 63.8% and 96.1%, respectively) at 24 h after surgery to be associated with in-hospital cardiac events. An elevation of both biomarkers above these threshold values was independently associated with individual postoperative complications (odds ratio, 18.9; 95%, CI, 2.3–106.1).

Conclusions

In elderly patients undergoing elective coronary artery bypass grafting surgery, high values of NT-proBNP and cTnT measured 24 h after the end of surgery were independently associated with in-hospital cardiac events.

Keywords

CARDIAC SURGERYCARDIOPULMONARY BYPASSELDERLYOUTCOMEPRO-BRAIN NATRIURETIC PEPTIDETROPONIN T
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 10 , October 2008 , pp. 834 - 841
Copyright
Copyright © European Society of Anaesthesiology 2008

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