Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis
The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated...
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| Veröffentlicht in: | The American journal of cardiology 2008-09, Vol.102 (6), p.749-754 |
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| creator | Pedrazzini, Giovanni Battista, MD Masson, Serge, PhD Latini, Roberto, MD Klersy, Catherine, MD, MSc Rossi, Maria Grazia, MD Pasotti, Elena, MD Faletra, Francesco Fulvio, MD Siclari, Francesco, MD Minervini, Fabrizio, MD Moccetti, Tiziano, MD Auricchio, Angelo, MD, PhD |
| description | The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 ± 9 years, mean aortic gradient 51 ± 18 mm Hg, and left ventricular ejection fraction 61 ± 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p |
| doi_str_mv | 10.1016/j.amjcard.2008.04.055 |
| format | Article |
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Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 ± 9 years, mean aortic gradient 51 ± 18 mm Hg, and left ventricular ejection fraction 61 ± 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p <0.001). Discrimination (based on C statistic) and model performance (based on Akaike information criterion) were better for BNP than for logES. At the bivariable analysis, only BNP was an independent predictor of death (HR 8.2, p = 0.002). Preoperative BNP was even more accurate than logES in predicting outcome. In conclusion, in symptomatic patients with severe AS, high preoperative BNP plasma level and high logES confirm their predicting value for short- and long-term outcome.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2008.04.055</identifier><identifier>PMID: 18774001</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Accuracy ; Age Factors ; Aged ; Aortic Valve - surgery ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Biological and medical sciences ; Brain ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Clinical outcomes ; Comparative analysis ; Coronary Artery Bypass ; Coronary Artery Disease - mortality ; Coronary Artery Disease - surgery ; Endocardial and cardiac valvular diseases ; Female ; Follow-Up Studies ; Heart ; Heart surgery ; Heart Valve Prosthesis ; Hospital Mortality ; Humans ; Male ; Medical sciences ; Mortality ; Natriuretic Peptide, Brain - blood ; Outcome Assessment (Health Care) ; Peptides ; Preoperative Care ; Prospective Studies ; Severity of Illness Index</subject><ispartof>The American journal of cardiology, 2008-09, Vol.102 (6), p.749-754</ispartof><rights>Elsevier Inc.</rights><rights>2008 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Sep 15, 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-a95c5f59cfd2d1460e39c0a27a1d9b29947a6958561849a718b31c4a54eef47e3</citedby><cites>FETCH-LOGICAL-c541t-a95c5f59cfd2d1460e39c0a27a1d9b29947a6958561849a718b31c4a54eef47e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2008.04.055$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20680616$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18774001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pedrazzini, Giovanni Battista, MD</creatorcontrib><creatorcontrib>Masson, Serge, PhD</creatorcontrib><creatorcontrib>Latini, Roberto, MD</creatorcontrib><creatorcontrib>Klersy, Catherine, MD, MSc</creatorcontrib><creatorcontrib>Rossi, Maria Grazia, MD</creatorcontrib><creatorcontrib>Pasotti, Elena, MD</creatorcontrib><creatorcontrib>Faletra, Francesco Fulvio, MD</creatorcontrib><creatorcontrib>Siclari, Francesco, MD</creatorcontrib><creatorcontrib>Minervini, Fabrizio, MD</creatorcontrib><creatorcontrib>Moccetti, Tiziano, MD</creatorcontrib><creatorcontrib>Auricchio, Angelo, MD, PhD</creatorcontrib><title>Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 ± 9 years, mean aortic gradient 51 ± 18 mm Hg, and left ventricular ejection fraction 61 ± 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p <0.001). Discrimination (based on C statistic) and model performance (based on Akaike information criterion) were better for BNP than for logES. At the bivariable analysis, only BNP was an independent predictor of death (HR 8.2, p = 0.002). Preoperative BNP was even more accurate than logES in predicting outcome. In conclusion, in symptomatic patients with severe AS, high preoperative BNP plasma level and high logES confirm their predicting value for short- and long-term outcome.</description><subject>Accuracy</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Biological and medical sciences</subject><subject>Brain</subject><subject>Cardiology</subject><subject>Cardiology. 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Vascular system</topic><topic>Cardiovascular</topic><topic>Clinical outcomes</topic><topic>Comparative analysis</topic><topic>Coronary Artery Bypass</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - surgery</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Heart Valve Prosthesis</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Outcome Assessment (Health Care)</topic><topic>Peptides</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pedrazzini, Giovanni Battista, MD</creatorcontrib><creatorcontrib>Masson, Serge, PhD</creatorcontrib><creatorcontrib>Latini, Roberto, MD</creatorcontrib><creatorcontrib>Klersy, Catherine, MD, MSc</creatorcontrib><creatorcontrib>Rossi, Maria Grazia, MD</creatorcontrib><creatorcontrib>Pasotti, Elena, MD</creatorcontrib><creatorcontrib>Faletra, Francesco Fulvio, MD</creatorcontrib><creatorcontrib>Siclari, Francesco, MD</creatorcontrib><creatorcontrib>Minervini, Fabrizio, MD</creatorcontrib><creatorcontrib>Moccetti, Tiziano, MD</creatorcontrib><creatorcontrib>Auricchio, Angelo, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pedrazzini, Giovanni Battista, MD</au><au>Masson, Serge, PhD</au><au>Latini, Roberto, MD</au><au>Klersy, Catherine, MD, MSc</au><au>Rossi, Maria Grazia, MD</au><au>Pasotti, Elena, MD</au><au>Faletra, Francesco Fulvio, MD</au><au>Siclari, Francesco, MD</au><au>Minervini, Fabrizio, MD</au><au>Moccetti, Tiziano, MD</au><au>Auricchio, Angelo, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2008-09-15</date><risdate>2008</risdate><volume>102</volume><issue>6</issue><spage>749</spage><epage>754</epage><pages>749-754</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 ± 9 years, mean aortic gradient 51 ± 18 mm Hg, and left ventricular ejection fraction 61 ± 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p <0.001). Discrimination (based on C statistic) and model performance (based on Akaike information criterion) were better for BNP than for logES. At the bivariable analysis, only BNP was an independent predictor of death (HR 8.2, p = 0.002). Preoperative BNP was even more accurate than logES in predicting outcome. In conclusion, in symptomatic patients with severe AS, high preoperative BNP plasma level and high logES confirm their predicting value for short- and long-term outcome.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18774001</pmid><doi>10.1016/j.amjcard.2008.04.055</doi><tpages>6</tpages></addata></record> |
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| subjects | Accuracy Age Factors Aged Aortic Valve - surgery Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Biological and medical sciences Brain Cardiology Cardiology. Vascular system Cardiovascular Clinical outcomes Comparative analysis Coronary Artery Bypass Coronary Artery Disease - mortality Coronary Artery Disease - surgery Endocardial and cardiac valvular diseases Female Follow-Up Studies Heart Heart surgery Heart Valve Prosthesis Hospital Mortality Humans Male Medical sciences Mortality Natriuretic Peptide, Brain - blood Outcome Assessment (Health Care) Peptides Preoperative Care Prospective Studies Severity of Illness Index |
| title | Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis |
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