Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery
Background Current preoperative models use clinical risk factors alone in estimating risk of in‐hospital mortality following cardiac surgery. However, novel biomarkers now exist to potentially improve preoperative prediction models. An assessment of Galectin‐3, N‐terminal pro b‐type natriuretic pept...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.008371 |
| _version_ | 1818774931080478720 |
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| author | Sai Polineni Devin M. Parker Shama S. Alam Heather Thiessen‐Philbrook Eric McArthur Anthony W. DiScipio David J. Malenka Chirag R. Parikh Amit X. Garg Jeremiah R. Brown |
| author_facet | Sai Polineni Devin M. Parker Shama S. Alam Heather Thiessen‐Philbrook Eric McArthur Anthony W. DiScipio David J. Malenka Chirag R. Parikh Amit X. Garg Jeremiah R. Brown |
| author_sort | Sai Polineni |
| collection | DOAJ |
| description | Background Current preoperative models use clinical risk factors alone in estimating risk of in‐hospital mortality following cardiac surgery. However, novel biomarkers now exist to potentially improve preoperative prediction models. An assessment of Galectin‐3, N‐terminal pro b‐type natriuretic peptide (NT‐ProBNP), and soluble ST2 to improve the predictive ability of an existing prediction model of in‐hospital mortality may improve our capacity to risk‐stratify patients before surgery. Methods and Results We measured preoperative biomarkers in the NNECDSG (Northern New England Cardiovascular Disease Study Group), a prospective cohort of 1554 patients undergoing coronary artery bypass graft surgery. Exposures of interest were preoperative levels of galectin‐3, NT‐ProBNP, and ST2. In‐hospital mortality and adverse events occurring after coronary artery bypass graft were the outcomes. After adjustment, NT‐ProBNP and ST2 showed a statistically significant association with both their median and third tercile categories with NT‐ProBNP odds ratios of 2.89 (95% confidence interval [CI]: 1.04–8.05) and 5.43 (95% CI: 1.21–24.44) and ST2 odds ratios of 3.96 (95% CI: 1.60–9.82) and 3.21 (95% CI: 1.17–8.80), respectively. The model receiver operating characteristic score of the base prediction model (0.80 [95% CI: 0.72–0.89]) varied significantly from the new multi‐marker model (0.85 [95% CI: 0.79–0.91]). Compared with the Northern New England (NNE) model alone, the full prediction model with biomarkers NT‐proBNP and ST2 shows significant improvement in model classification of in‐hospital mortality. Conclusions This study demonstrates a significant improvement of preoperative prediction of in‐hospital mortality in patients undergoing coronary artery bypass graft and suggests that biomarkers can be used to identify patients at higher risk. |
| first_indexed | 2024-12-18T10:48:59Z |
| format | Article |
| id | doaj.art-cceb16d4ed18466dafe7c9a2b03ee977 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:48:59Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-cceb16d4ed18466dafe7c9a2b03ee9772022-12-21T21:10:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-07-0171410.1161/JAHA.117.008371Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac SurgerySai Polineni0Devin M. Parker1Shama S. Alam2Heather Thiessen‐Philbrook3Eric McArthur4Anthony W. DiScipio5David J. Malenka6Chirag R. Parikh7Amit X. Garg8Jeremiah R. Brown9The Dartmouth Institute for Health Policy & Clinical Practice Geisel School of Medicine Lebanon NHThe Dartmouth Institute for Health Policy & Clinical Practice Geisel School of Medicine Lebanon NHThe Dartmouth Institute for Health Policy & Clinical Practice Geisel School of Medicine Lebanon NHProgram of Applied Translational Research Yale School of Medicine New Haven CTInstitute for Clinical Evaluative Sciences Ontario CanadaDartmouth‐Hitchcock Medical Center Lebanon NHDartmouth‐Hitchcock Medical Center Lebanon NHProgram of Applied Translational Research Yale School of Medicine New Haven CTInstitute for Clinical Evaluative Sciences Ontario CanadaThe Dartmouth Institute for Health Policy & Clinical Practice Geisel School of Medicine Lebanon NHBackground Current preoperative models use clinical risk factors alone in estimating risk of in‐hospital mortality following cardiac surgery. However, novel biomarkers now exist to potentially improve preoperative prediction models. An assessment of Galectin‐3, N‐terminal pro b‐type natriuretic peptide (NT‐ProBNP), and soluble ST2 to improve the predictive ability of an existing prediction model of in‐hospital mortality may improve our capacity to risk‐stratify patients before surgery. Methods and Results We measured preoperative biomarkers in the NNECDSG (Northern New England Cardiovascular Disease Study Group), a prospective cohort of 1554 patients undergoing coronary artery bypass graft surgery. Exposures of interest were preoperative levels of galectin‐3, NT‐ProBNP, and ST2. In‐hospital mortality and adverse events occurring after coronary artery bypass graft were the outcomes. After adjustment, NT‐ProBNP and ST2 showed a statistically significant association with both their median and third tercile categories with NT‐ProBNP odds ratios of 2.89 (95% confidence interval [CI]: 1.04–8.05) and 5.43 (95% CI: 1.21–24.44) and ST2 odds ratios of 3.96 (95% CI: 1.60–9.82) and 3.21 (95% CI: 1.17–8.80), respectively. The model receiver operating characteristic score of the base prediction model (0.80 [95% CI: 0.72–0.89]) varied significantly from the new multi‐marker model (0.85 [95% CI: 0.79–0.91]). Compared with the Northern New England (NNE) model alone, the full prediction model with biomarkers NT‐proBNP and ST2 shows significant improvement in model classification of in‐hospital mortality. Conclusions This study demonstrates a significant improvement of preoperative prediction of in‐hospital mortality in patients undergoing coronary artery bypass graft and suggests that biomarkers can be used to identify patients at higher risk.https://www.ahajournals.org/doi/10.1161/JAHA.117.008371cardiac biomarkerscardiac surgerymortalityoutcomes research |
| spellingShingle | Sai Polineni Devin M. Parker Shama S. Alam Heather Thiessen‐Philbrook Eric McArthur Anthony W. DiScipio David J. Malenka Chirag R. Parikh Amit X. Garg Jeremiah R. Brown Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac biomarkers cardiac surgery mortality outcomes research |
| title | Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery |
| title_full | Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery |
| title_fullStr | Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery |
| title_full_unstemmed | Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery |
| title_short | Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery |
| title_sort | predictive ability of novel cardiac biomarkers st2 galectin 3 and nt probnp before cardiac surgery |
| topic | cardiac biomarkers cardiac surgery mortality outcomes research |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.008371 |
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