Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery
The NAPA Trial
Robert M. Mentzer, Jr, MD, FACC*,*,
Mehmet C. Oz, MD, FACC ,
Robert N. Sladen, MD, FCCM ,
Allen H. Graeve, MD, FACS ,
Robert F. Hebeler, Jr, MD||,
John M. Luber, Jr, MD, FACS¶,
Nicholas G. Smedira, MD, FACC# on behalf of the NAPA Investigators
* Division of Cardiothoracic Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
Division of Cardiothoracic Surgery, College of Physicians & Surgeons, Columbia University, New York, New York
Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, New York
MultiCare Cardiothoracic Surgical Associates, Tacoma General Hospital, Tacoma, Washington
|| Department of Surgery, Baylor University Medical Center, Dallas, Texas
¶ Franciscan Health System Research Center, Tacoma, Washington
# Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio
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Figure 2 Time Course of SCr Response
Mean change from baseline in postoperative (post-op) serum creatinine (SCr) values over the course of the hospital stay in nesiritide (solid line) and placebo (dotted line) patients. Vertical lines signify 1 SEM. *p < 0.05 nesiritide versus placebo on the basis of longitudinal repeated measures analysis of variance model; p < 0.05 change from baseline on the basis of paired t test. ICU = intensive care unit.
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Figure 3 Maximal Change in SCr and GFR by Baseline Renal Function
Adjusted mean maximum increase in serum creatinine (SCr) (A, B, and C) and decrease in glomerular filtration rate (GFR) (D, E, and F) from baseline through hospital discharge or by study day 14, whichever came first, using an analysis of covariance model. Lines above the bars represent 1 SEM.
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Figure 4 Time Course of Hemodynamic Parameters During the Initial 24 Postoperative Hours
Mean pulmonary artery pressure (A), pulmonary capillary wedge pressure (B), mean arterial pressure (C), central venous pressure (D), cardiac index (E), and systemic vascular resistance (F) at baseline and over the initial 24 postoperative hours in nesiritide (solid lines) and placebo (dotted lines) patients. Points represent mean values and vertical lines represent 1 SEM. The p values are for nesiritide versus placebo comparison using a longitudinal repeated measures analysis of variance model.
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