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Rao RA, Varghese SS, Ansari F, Rao A, Meng E, El-Diasty M. The Role of Natriuretic Peptides in Predicting Adverse Outcomes After Cardiac Surgery: An Updated Systematic Review. Am J Cardiol 2024; 210:16-36. [PMID: 37884264 DOI: 10.1016/j.amjcard.2023.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
The increasing global burden of cardiovascular disease, particularly, in the aging population, has led to an increase in high-risk cardiac surgical procedures. The current preoperative risk stratification scores, such as the European System for Cardiac Operative Risk Evaluation and the Society for Thoracic Surgeons score, have limitations in their predictive accuracy and tend to underestimate the mortality risk in higher-risk populations. This systematic review aimed to evaluate the utility of natriuretic peptides, brain natriuretic peptide (BNP) and its precursor prohormone (N-terminal prohormone BNP), as predictive biomarkers for adverse outcomes after cardiac surgery. A comprehensive search strategy was performed, and 63 studies involving 40,667 patients who underwent major cardiac operations were included for data extraction. Preoperative levels of BNP and N-terminal prohormone BNP seemed to be associated with an increased risk of short- and long-term mortality, postoperative heart failure, kidney injury, and length of intensive care unit stay. However, their predictive value for postoperative arrhythmias and myocardial infarction was less established. Our findings suggest that natriuretic peptides may play an important role in risk prediction in patients who underwent cardiac surgery. The addition of these biomarkers to the existing clinical risk stratification strategies may enhance their predictive accuracy. However, this needs to be endorsed by data derived from wide-scale clinical trials.
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Affiliation(s)
- Reddi Ashwin Rao
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | | | - Farzan Ansari
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Aditya Rao
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Eric Meng
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Mohammad El-Diasty
- Harrington Heart and Vascular Institute, Cardiac Surgery Department, University Hospitals, Cleveland, Ohio.
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Brown JR, Parker D, Stabler ME, Jacobs ML, Jacobs JP, Everett AD, Lobdell KW, Wyler von Ballmoos MC, Thiessen-Philbrook H, Parikh C, Mackenzie T, DiScipio A, Malenka D, Matheny ME, Turchin A, Likosky DS. Improving the prediction of long-term readmission and mortality using a novel biomarker panel. J Card Surg 2021; 36:4213-4223. [PMID: 34472654 PMCID: PMC8560027 DOI: 10.1111/jocs.15954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Several short-term readmission and mortality prediction models have been developed using clinical risk factors or biomarkers among patients undergoing coronary artery bypass graft (CABG) surgery. The use of biomarkers for long-term prediction of readmission and mortality is less well understood. Given the established association of cardiac biomarkers with short-term adverse outcomes, we hypothesized that 5-year prediction of readmission or mortality may be significantly improved using cardiac biomarkers. MATERIALS AND METHODS Plasma biomarkers from 1149 patients discharged alive after isolated CABG surgery from eight medical centers were measured in a cohort from the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. We assessed the added predictive value of a biomarker panel with a clinical model against the clinical model alone and compared the model discrimination using the area under the receiver operating characteristic (AUROC) curves. RESULTS In our cohort, 461 (40%) patients were readmitted or died within 5 years. Long-term outcomes were predicted by applying the STS ASCERT clinical model with an AUROC of 0.69. The biomarker panel with the clinical model resulted in a significantly improved AUROC of 0.74 (p value <.0001). Across 5 years, the hazard ratio for patients in the second to fifth quintile predicted probabilities from the biomarker augmented STS ASCERT model ranged from 2.2 to 7.9 (p values <.001). CONCLUSIONS We report that a panel of biomarkers significantly improved prediction of long-term readmission or mortality risk following CABG surgery. Our findings suggest biomarkers help clinical care teams better assess the long-term risk of readmission or mortality.
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Affiliation(s)
- Jeremiah R. Brown
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, NH,Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, NH
| | - Devin Parker
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Meagan E. Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Marshall L. Jacobs
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey P. Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Allen D. Everett
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Chirag Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Todd Mackenzie
- Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, NH
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Sato M, Mutai H, Yamamoto S, Tsukakoshi D, Takeda S, Oguchi N, Ichimura H, Ikegami S, Wada Y, Seto T, Horiuchi H. Decreased activities of daily living at discharge predict mortality and readmission in elderly patients after cardiac and aortic surgery: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26819. [PMID: 34397842 PMCID: PMC8341368 DOI: 10.1097/md.0000000000026819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan-Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.
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Affiliation(s)
- Masaaki Sato
- Division of Occupational Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Hitoshi Mutai
- Division of Occupational Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Daichi Tsukakoshi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Shuhei Takeda
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Natsuko Oguchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Hajime Ichimura
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shota Ikegami
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuichiro Seto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
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Gupta D, Jacobs JP, Bleiweis MS. Quest for Biomarkers in Pediatric Cardiac Surgery. Ann Thorac Surg 2021; 113:180-181. [PMID: 33607057 DOI: 10.1016/j.athoracsur.2020.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Dipankar Gupta
- Department of Pediatrics, Congenital Heart Center, University of Florida, 1600 SW Archer Rd, HD 314B, Gainesville, FL 32610.
| | - Jeffrey P Jacobs
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Mark S Bleiweis
- Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
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Lazar HL. Commentary: Risk stratification for patients undergoing surgical ventricular restoration for ischemic cardiomyopathy-it's more than just the preoperative ejection fraction. J Thorac Cardiovasc Surg 2020; 164:1102-1103. [PMID: 33158563 DOI: 10.1016/j.jtcvs.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
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Liu N, Hang T, Gao X, Yang W, Kong W, Lou Q, Yang J. The association between soluble suppression of tumorigenicity-2 and long-term prognosis in patients with coronary artery disease: A meta-analysis. PLoS One 2020; 15:e0238775. [PMID: 32886697 PMCID: PMC7473587 DOI: 10.1371/journal.pone.0238775] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Findings regarding the prognostic value of soluble suppression of tumorigenecity-2 (sST2) in patients with coronary artery disease (CAD) remain inconsistent. Therefore, we conducted this meta-analysis to investigate the long-term prognostic value of sST2 in patients with CAD. METHODS A comprehensive literature search was conducted across the PubMed, Embase, and Cochrane Library databases up to June 3, 2020. The primary outcome was major adverse cardiac events (MACEs). The secondary outcomes were all-cause mortality, cardiovascular (CV) death, heart failure (HF), and myocardial infarction (MI). Pooled estimations and 95% confidence intervals (CIs) were assessed using a random-effects model. RESULTS Twenty-two articles that enrolled a total of 17,432 patients with CAD were included in the final analysis. CAD patients in the highest categories of baseline sST2 had a significantly higher risk of MACEs (HR: 1.42, 95% CI: 1.09-1.76), all-cause mortality (HR: 2.00, 95% CI: 1.54-2.46), and CV death (HR: 1.42, 95% CI: 1.15-1.68), HF (HR: 2.41, 95% CI: 1.87-2.94), but not that of MI (HR: 1.15, 95% CI: -0.73-3.04), than those in the lowest categories. These results were consistent when baseline sST2 was presented as continuous values in one unit increments. Moreover, subgroup analysis showed that elevated baseline sST2 levels increased the long-term risk of MACEs in the acute coronary syndrome (ACS) population (HR: 1.74, 95% CI: 1.39-2.09) but only showed a trend toward higher risk of MACEs in the non-ACS population (HR: 1.09, 95% CI: 0.87-1.30). CONCLUSIONS The findings suggest that a higher concentration of baseline sST2 is associated with a higher risk of MACEs, all-cause mortality, CV death, and HF in patients with CAD. Elevated sST2 levels could significantly predict future MACEs in the ACS population but not in the non-ACS population.
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Affiliation(s)
- Niannian Liu
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Hang
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Gao
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenxue Yang
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjie Kong
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiaozhen Lou
- Department of Cardiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiming Yang
- Department of Cardiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Goodwin ML, Selzman CH. Take a load off: Unloading and reperfusion. J Thorac Cardiovasc Surg 2020; 161:2046-2050. [PMID: 32859423 DOI: 10.1016/j.jtcvs.2020.07.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew L Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
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Patel DM, Thiessen-Philbrook H, Brown JR, McArthur E, Moledina DG, Mansour SG, Shlipak MG, Koyner JL, Kavsak P, Whitlock RP, Everett AD, Malenka DJ, Garg AX, Coca SG, Parikh CR. Association of plasma-soluble ST2 and galectin-3 with cardiovascular events and mortality following cardiac surgery. Am Heart J 2020; 220:253-263. [PMID: 31911262 PMCID: PMC7008086 DOI: 10.1016/j.ahj.2019.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 11/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiac surgery induces hemodynamic stress on the myocardium, and this process can be associated with significant post-operative morbidity and mortality. Soluble suppression of tumorigenicity 2 (sST2) and galectin-3 (gal-3) are biomarkers of myocardial remodeling and fibrosis; however, their potential association with post-operative changes is unknown. METHODS We measured peri-operative plasma sST2 and gal-3 levels in two prospective cohorts (TRIBE-AKI and NNE) of over 1800 patients who underwent cardiac surgery. sST2 and gal-3 levels were evaluated for association with a composite primary outcome of cardiovascular event or mortality over median follow-up periods of 3.4 and 6.0 years, respectively, for the two cohorts. Meta-analysis of hazard ratio estimates from the cohorts was performed using random effects models. RESULTS Cohorts demonstrated event rates of 70.2 and 66.8 per 1000 person-years for the primary composite outcome. After adjustment for clinical covariates, higher post-operative sST2 and gal-3 levels were significantly associated with cardiovascular event or mortality [pooled estimate HRs: sST2 1.29 (95% CI 1.16, 1.44); gal-3 1.26 (95% CI 1.09, 1.46)]. These associations were not significantly modified by pre-operative congestive heart failure or AKI. CONCLUSIONS Higher post-operative sST2 and gal-3 values were associated with increased incidence of cardiovascular event or mortality. These two biomarkers should be further studied for potential clinical utility for patients undergoing cardiac surgery.
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Affiliation(s)
- Dipal M Patel
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Jeremiah R Brown
- Dartmouth Institute for Health Policy and Clinical Practice, and the Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine, Lebanon, NH
| | | | - Dennis G Moledina
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT; Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Sherry G Mansour
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT; Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Michael G Shlipak
- Kidney Health Research Collaborative, University of California San Francisco, San Francisco, CA; Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, CA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Peter Kavsak
- Departments of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute and Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - David J Malenka
- Dartmouth Institute for Health Policy and Clinical Practice, and the Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine, Lebanon, NH
| | - Amit X Garg
- ICES, Toronto, ON, Canada; Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD.
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Everett AD, Alam SS, Owens SL, Parker DM, Goodrich C, Likosky DS, Thiessen-Philbrook H, Wyler von Ballmoos M, Lobdell K, MacKenzie TA, Jacobs J, Parikh CR, DiScipio AW, Malenka DJ, Brown JR. The Association between Cytokines and 365-Day Readmission or Mortality in Adult Cardiac Surgery. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2019; 51:201-209. [PMID: 31915403 PMCID: PMC6936301 DOI: 10.1182/ject-1900014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/26/2019] [Indexed: 11/20/2022]
Abstract
Cardiac surgery results in a multifactorial systemic inflammatory response with inflammatory cytokines, such as interleukin-10 and 6 (IL-10 and IL-6), shown to have potential in the prediction of adverse outcomes including readmission or mortality. This study sought to measure the association between IL-6 and IL-10 levels and 1-year hospital readmission or mortality following cardiac surgery. Plasma biomarkers IL-6 and IL-10 were measured in 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from eight medical centers participating in the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. Readmission status and mortality were ascertained using Medicare, state all-payer claims, and the National Death Index. We evaluated the association between preoperative and postoperative cytokines and 1-year readmission or mortality using Kaplan-Meier estimates and Cox's proportional hazards modeling, adjusting for covariates used in the Society of Thoracic Surgeons 30-day readmission model. The median follow-up time was 1 year. After adjustment, patients in the highest tertile of postoperative IL-6 values had a significantly increased risk of readmission or death within 1 year (HR: 1.38; 95% CI: 1.03-1.85), and an increased risk of death within 1 year of discharge (HR: 4.88; 95% CI: 1.26-18.85) compared with patients in the lowest tertile. However, postoperative IL-10 levels, although increasing through tertiles, were not found to be significantly associated independently with 1-year readmission or mortality (HR: 1.25; 95% CI: .93-1.69). Pro-inflammatory cytokine IL-6 and anti-inflammatory cytokine IL-10 may be postoperative markers of cardiac injury, and IL-6, specifically, shows promise in predicting readmission and mortality following cardiac surgery.
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Affiliation(s)
- Allen D. Everett
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shama S. Alam
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Sherry L. Owens
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Devin M. Parker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Christine Goodrich
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Heather Thiessen-Philbrook
- Department of Internal Medicine and Program of Applied Translational Research Yale University School of Medicine, New Haven, Connecticut
| | - Moritz Wyler von Ballmoos
- Department of Thoracic and Cardiovascular Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Kevin Lobdell
- Carolinas Healthcare System, Charlotte, North Carolina
| | - Todd A. MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jeffrey Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Chirag R. Parikh
- Department of Internal Medicine and Program of Applied Translational Research Yale University School of Medicine, New Haven, Connecticut
| | - Anthony W. DiScipio
- Department of Surgery and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J. Malenka
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | - Jeremiah R. Brown
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
- Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, New Hampshire
- Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire
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10
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Ramkumar N, Jacobs JP, Berman RB, Parker DM, MacKenzie TA, Likosky DS, DiScipio A, Malenka DJ, Brown JR. Cardiac Biomarkers Predict Long-term Survival After Cardiac Surgery. Ann Thorac Surg 2019; 108:1776-1782. [PMID: 31255614 DOI: 10.1016/j.athoracsur.2019.04.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac biomarkers soluble ST-2 (sST-2) and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) may be associated with long-term survival after cardiac surgery. This study explored the relationship between long-term survival after cardiac surgery and serum biomarker levels. METHODS Patients undergoing cardiac surgery from 2004 to 2007 were enrolled in a prospective biomarker cohort in the Northern New England Cardiovascular Disease Study Group Registry. Preoperative serum biomarker levels, postoperative serum biomarker levels, and the change in serum biomarker levels were categorized by quartile. The study used Kaplan-Meier survival analysis and Cox regression models adjusted for variables in the American College of Cardiology Foundation-Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategy (ASCERT) long-term survival calculator to study the association of biomarker levels with long-term survival. After Kaplan-Meier analysis, quartiles 2 and 3 were found to have similar survival and were therefore combined into 1 category. RESULTS In the study cohort (n = 1648), median follow-up time was 8.5 years (interquartile range, 7.6-9.7 years), during which there were 227 deaths. The 10-year survival rate was 86%. Kaplan-Meier survival analysis demonstrated a significant (P < .001) difference across quartiles of each biomarker level measurement. After adjustment, preoperative levels, postoperative levels, and the change in biomarker levels in quartile 4 (highest serum levels or change) were significantly predictive of worse survival (hazard ratio range, 1.77-2.89; all P < .05) compared with quartile 1; however, levels of sST-2 and NT-proBNP in quartiles 2 and 3 demonstrated a nonstatistically significant trend with long-term survival. CONCLUSIONS Elevated preoperative and postoperative levels of sST-2 or NT-proBNP and large changes in these biomarkers' levels are associated with an increased risk of worse survival after cardiac surgery. These biomarkers can be used for risk stratification or assessing postsurgical prognosis.
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Affiliation(s)
- Niveditta Ramkumar
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, Tampa, Florida
| | - Richard B Berman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Devin M Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anthony DiScipio
- Section of Cardiology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David J Malenka
- Section of Cardiology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Hanover, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire.
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11
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Affiliation(s)
- Devin M Parker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, NH 03756, USA
| | - Jeremiah R Brown
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Lebanon, NH 03756, USA
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