Journal of thoracic disease · 2025
Prognostic value of cardiac biomarkers in surgery for acute type A aortic dissection: mid-term follow-up results.
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Zhou Sangyu, Liu Yanxiang, Zhang Bowen, Wang Luchen, Xie Mingxin, Wang Haoyu, Sun Xiaogang
Аннотация
BACKGROUND: There is a paucity of data on the prognostic value of cardiac biomarkers in surgery for acute type A aortic dissection (ATAAD), especially lacking follow-up data. We aimed to explore the association between cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and short- and mid-term survival in surgery for ATAAD.
METHODS: A total of 535 patients undergoing surgery for ATAAD were retrospectively enrolled. Cardiac biomarkers were measured before surgery. Receiver operating characteristic curve was used to explore the cut-off value of NT-proBNP for predicting 30-day mortality. Logistic regression analysis evaluated the association between cTnI and NT-proBNP and short-term mortality. Cox proportional hazards analysis was performed to explore the association between cTnI and the NT-proBNP and mid-term survival.
RESULTS: cTnI {0.022 [interquartile range (IQR), 0.005-0.093] vs. 0.006 (IQR, 0.002-0.027) ng/mL, P=0.002} and NT-proBNP [676 (IQR, 185-2,349) vs. 279 (IQR, 96-815) pg/mL, P=0.02] were significantly higher in the non-survivor group. Multivariable logistic regression analysis identified that positive cTnI [odds ratio (OR): 2.268, 95% confidence interval (CI): 1.148-6.016, P=0.02] and NT-proBNP ≥1,169.6 pg/mL (OR: 2.437, 95% CI: 1.050-5.654, P=0.04) were independent risk factors for short-term mortality. Multivariable Cox proportional hazards analysis showed that NT-proBNP ≥1,169.6 pg/mL [hazard ratio (HR): 2.531, 95% CI: 1.323-4.843, P=0.005] was an independent risk factor for mid-term survival.
CONCLUSIONS: NT-proBNP showed important prognostic value in not only short-term but also mid-term survival in patients undergoing surgery for ATAAD. cTnI was also associated with short-term mortality. Both NT-proBNP and cTnI could serve as early biomarkers for the risk stratification of patients with ATAAD.
METHODS: A total of 535 patients undergoing surgery for ATAAD were retrospectively enrolled. Cardiac biomarkers were measured before surgery. Receiver operating characteristic curve was used to explore the cut-off value of NT-proBNP for predicting 30-day mortality. Logistic regression analysis evaluated the association between cTnI and NT-proBNP and short-term mortality. Cox proportional hazards analysis was performed to explore the association between cTnI and the NT-proBNP and mid-term survival.
RESULTS: cTnI {0.022 [interquartile range (IQR), 0.005-0.093] vs. 0.006 (IQR, 0.002-0.027) ng/mL, P=0.002} and NT-proBNP [676 (IQR, 185-2,349) vs. 279 (IQR, 96-815) pg/mL, P=0.02] were significantly higher in the non-survivor group. Multivariable logistic regression analysis identified that positive cTnI [odds ratio (OR): 2.268, 95% confidence interval (CI): 1.148-6.016, P=0.02] and NT-proBNP ≥1,169.6 pg/mL (OR: 2.437, 95% CI: 1.050-5.654, P=0.04) were independent risk factors for short-term mortality. Multivariable Cox proportional hazards analysis showed that NT-proBNP ≥1,169.6 pg/mL [hazard ratio (HR): 2.531, 95% CI: 1.323-4.843, P=0.005] was an independent risk factor for mid-term survival.
CONCLUSIONS: NT-proBNP showed important prognostic value in not only short-term but also mid-term survival in patients undergoing surgery for ATAAD. cTnI was also associated with short-term mortality. Both NT-proBNP and cTnI could serve as early biomarkers for the risk stratification of patients with ATAAD.