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CLINICAL RESEARCH: ACUTE AORTIC SYNDROME

Pre-Operative N-Terminal Pro-Brain Natriuretic Peptide Predicts Outcome in Type A Aortic Dissection

Gottfried Sodeck, MD^_*, Hans Domanovits, MD^_*,_*, Martin Schillinger, MD, Karin Janata, MD^_*, Markus Thalmann, MD, Marek P. Ehrlich, MD, Georg Endler, MD and Anton Laggner, MD^_*

^_* Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
Department of Angiology, Medical University Vienna, Vienna, Austria
Department of Cardiothoracic Surgery, Medical University Vienna, Vienna, Austria
Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria.

Manuscript received April 27, 2007; revised manuscript received October 10, 2007, accepted December 10, 2007.

^_* Reprint requests and correspondence to: Dr. Hans Domanovits, Department of Emergency Medicine, Vienna General Hospital, Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria. (Email: hans.domanovits{at}meduniwien.ac.at).

Background: Acute Stanford type A aortic dissection (AAD) is associated with substantial perioperative mortality and morbidity.

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a prognostic biomarker of outcome in cardiovascular disease. Its predictive power in patients undergoing emergency surgery for acute type A aortic dissection is yet unknown.

Methods: We prospectively measured pre-operative NT-proBNP in 104 patients (39 female, 35%; median age 61 years) undergoing emergency surgery for AAD during a 6-year study period. European System for Cardiac Operative Risk Evaluation risk scores were recorded and patients were followed for 30-day mortality and major adverse events (MAEs) as defined by the need for rethoracotomy, occurrence of postoperative heart failure, neurologic deficit, lung failure, renal failure, or sepsis.

Results: Median logistic European System for Cardiac Operative Risk Evaluation in the cohort was 12 (interquartile range 7 to 19). During the first 30 days, 23 patients (22%) died, and 53 patients (51%) experienced MAEs. Median (interquartile range) NT-proBNP levels in survivors versus nonsurvivors were 328 pg/ml (157 to 569) versus 2,240 pg/ml (515 to 4,734; p < 0.001), and in patients without versus with MAEs, 227 pg/ml (107 to 328) and 719 pg/ml (442 to 2,287; p < 0.001), respectively. Adjusted odds ratios for increasing tertiles of NT-proBNP compared with the lowest tertile were 0.98 (95% confidence interval [CI] 0.18 to 5.33; p = 0.98) and 11.67 (95% CI 2.61 to 52.09; p = 0.001) for 30-day mortality and 9.07 (95% CI 2.58 to 31.83; p = 0.001) and 50.21 (95% CI 10.85 to 232.45; p < 0.001) for MAEs, respectively, indicating a significant association between pre-operative NT-proBNP levels and outcome.

Conclusions: Pre-operative NT-proBNP predicts outcome in patients undergoing surgery of AAD.

Abbreviations and Acronyms   CI = confidence interval   EuroSCORE = European System for Cardiac Operative Risk Evaluation   IQR = interquartile range   MAE = major adverse event   NT-proBNP = N-terminal pro-brain natriuretic peptide   OR = odds ratio