Holm Jonas, Vidlund Mårten, Vanky Farkas, Friberg Orjan, Håkanson Erik, Svedjeholm Rolf
Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping University, Linköping, Sweden.
Scand Cardiovasc J Suppl. 2013 Feb;47(1):28-35. doi: 10.3109/14017431.2012.731518. Epub 2012 Oct 10.
The predictive value of preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated in patients with acute coronary syndrome undergoing coronary artery bypass grafting (CABG).
As a substudy to a clinical trial 383 patients with acute coronary syndrome undergoing CABG were studied. 17 patients had a concomitant procedure. NT-proBNP was measured immediately preoperatively and evaluated with regard to in-hospital mortality, and severe circulatory failure postoperatively according to prespecified criteria. Follow-up was 3.2 ± 0.9 years.
In patients with isolated CABG, receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.82 for in-hospital mortality and 0.87 for severe circulatory failure respectively with a best cut-off for preoperative NT-proBNP of 1028 ng/L. This cut-off level independently predicted severe circulatory failure. Patients with NT-proBNP < 1028 ng/L had significantly better long-term survival (p = 0.004). Preoperative NT-proBNP was higher in patients with concomitant procedure than isolated CABG (2146 ± 1858 v 887 ± 1635 ng/L; p = 0.0005). In patients with concomitant procedure ROC analysis showed an AUC of 0.93 for severe circulatory failure with a best cut-off for preoperative NT-proBNP of 3145 ng/L.
Preoperative NT-proBNP predicted in-hospital mortality, severe circulatory failure postoperatively and long-term survival in patients undergoing surgery for acute coronary syndrome but a higher threshold was found in patients having concomitant procedures.
评估术前N末端B型利钠肽原（NT-proBNP）对接受冠状动脉旁路移植术（CABG）的急性冠状动脉综合征患者的预测价值。
作为一项临床试验的子研究，对383例接受CABG的急性冠状动脉综合征患者进行了研究。17例患者同时进行了其他手术。术前即刻测量NT-proBNP，并根据预先设定的标准评估其与院内死亡率及术后严重循环衰竭的关系。随访时间为3.2±0.9年。
在单纯CABG患者中，受试者工作特征（ROC）分析显示，院内死亡率的曲线下面积（AUC）为0.82，严重循环衰竭的AUC为0.87，术前NT-proBNP的最佳截断值为1028 ng/L。该截断水平可独立预测严重循环衰竭。NT-proBNP<1028 ng/L的患者长期生存率显著更高（p=0.004）。同时进行其他手术的患者术前NT-proBNP高于单纯CABG患者（2146±1858 vs 887±1635 ng/L；p=0.0005）。在同时进行其他手术的患者中，ROC分析显示严重循环衰竭的AUC为0.93，术前NT-proBNP的最佳截断值为3145 ng/L。
术前NT-proBNP可预测急性冠状动脉综合征手术患者的院内死亡率、术后严重循环衰竭及长期生存率，但同时进行其他手术的患者阈值更高。
