Differential release kinetics of cardiac biomarkers in off-pump coronary bypass. (July 2014)

• Record Type: Journal Article
• Authors: Singh, Satyajit; Kapoor, Aditya; Agarwal, Surendra Kumar; Pande, Shantanu; Sinha, Archana; Rai, Himanshu; Kumar, Sudeep; Tewari, Satyendra; Garg, Naveen; Majumdar, Gauranga; Chandra, Bipin; Goel, Pravin K
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 22:Number 6(2014)
• Page Start: 674
• Page End: 681
• Publication Date: 2014-07
• Subjects: Biological markers -- coronary artery bypass -- off-pump -- natriuretic peptide -- brain -- prognosis -- troponin I; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492313504420
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Differential release kinetics of the cardiac biomarkers (B-type natriuretic peptide, troponin I, and creatine kinase-MB) following off-pump coronary artery bypass are not well characterized. Methods: Biomarker levels were assessed at 6, 24, 48 h, and 1 month preoperatively, in 80 patients who underwent off-pump coronary artery bypass. Results: All biomarkers increased within 6 h of surgery. Peak B-type natriuretic peptide levels occurred at 24–48 h in 96% of patients, but only two-thirds had peak troponin I and creatine kinase-MB levels at this time, reflecting different release patterns. Levels of all biomarkers declined within 48 h, but 42% of patients still had B-type natriuretic peptide >100 pg·mL −1 at 1 month. Those with baseline B-type natriuretic peptide > 100 pg·mL −1 had a lower left ventricular ejection fraction (43.6% vs. 55.6%, p < 0.01) and longer inotropic (43.8 vs. 31.4 h, p = 0.03) and ventilator support (34 vs. 25.5 h, p = 0.04) than those with lower levels. B-type natriuretic peptide levels correlated positively with angiographic Syntax score ( p = 0.02) and negatively with left ventricular ejection fraction ( p < 0.001). Only baseline B-type natriuretic peptide predicted the durations of inotropic support ( p = 0.01) and ventilation ( p = 0.02). Postoperative B-type natriuretic peptide at 6, 24, and 48 h and delta B-type natriuretic peptide were significant predictors of mean ventilation time. Conclusion: Even in patients undergoing off-pump surgery, there is significant natriuretic peptide and myocardial enzyme release. Only B-type natriuretic peptide levels had an association with postoperative variables.