Jeffrey P Jacobs1, Shama S Alam2, Sherry L Owens2, Devin M Parker2, Michael Rezaee2, Donald S Likosky3, David M Shahian4, Marshall L Jacobs1, Heather Thiessen-Philbrook5, Moritz Wyler von Ballmoos6, Kevin Lobdell7, Todd MacKenzie8, Allen D Everett9, Chirag R Parikh5, Jeremiah R Brown10. 1. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St. Petersburg, Tampa, and Orlando, Florida. 2. Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. 3. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 4. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 5. Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. 6. Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. 7. Carolinas HealthCare System, Charlotte, North Carolina. 8. Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. 9. Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. 10. Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Electronic address: jeremiah.r.brown@dartmouth.edu.
Abstract
BACKGROUND: Novel cardiac biomarkers including soluble suppression of tumorigenicity 2, galectin-3, and the N-terminal prohormone of brain natriuretic peptide may be associated with long-term adverse outcomes after cardiac surgery. We sought to measure the association between cardiac biomarker levels and 1-year hospital readmission or mortality. METHODS: Plasma biomarkers from 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from 8 medical centers were measured in a cohort from the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. We evaluated the association between preoperative and postoperative biomarkers and 1-year readmission or mortality using Kaplan-Meier estimates and Cox proportional hazards modeling, adjusting for covariates used in The Society of Thoracic Surgeons 30-day readmission model. RESULTS: The median follow-up time was 365 days. After adjustment for established risk factors, above-median levels of postoperative galectin-3 (median 10.35 ng/mL; hazard ratio, 1.40; 95% confidence interval, 1.08 to 1.80; p = 0.010) and N-terminal prohormone of brain natriuretic peptide (median = 15.21 ng/mL, hazard ratio, 1.42; 95% confidence interval, 1.07 to 1.87; p = 0.014) were each significantly associated with 1-year readmission or mortality. CONCLUSIONS: In patients undergoing cardiac surgery, novel cardiac biomarkers were associated with readmission or mortality independent of established risk factors. Measurement of these biomarkers may improve our ability to identify patients at highest risk for readmission or mortality before discharge. This will also allow resource allocation accordingly, while implementing strategies for personalized medicine based on the biomarker profile of the patient.
BACKGROUND:Novel cardiac biomarkers including soluble suppression of tumorigenicity 2, galectin-3, and the N-terminal prohormone of brain natriuretic peptide may be associated with long-term adverse outcomes after cardiac surgery. We sought to measure the association between cardiac biomarker levels and 1-year hospital readmission or mortality. METHODS: Plasma biomarkers from 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from 8 medical centers were measured in a cohort from the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. We evaluated the association between preoperative and postoperative biomarkers and 1-year readmission or mortality using Kaplan-Meier estimates and Cox proportional hazards modeling, adjusting for covariates used in The Society of Thoracic Surgeons 30-day readmission model. RESULTS: The median follow-up time was 365 days. After adjustment for established risk factors, above-median levels of postoperative galectin-3 (median 10.35 ng/mL; hazard ratio, 1.40; 95% confidence interval, 1.08 to 1.80; p = 0.010) and N-terminal prohormone of brain natriuretic peptide (median = 15.21 ng/mL, hazard ratio, 1.42; 95% confidence interval, 1.07 to 1.87; p = 0.014) were each significantly associated with 1-year readmission or mortality. CONCLUSIONS: In patients undergoing cardiac surgery, novel cardiac biomarkers were associated with readmission or mortality independent of established risk factors. Measurement of these biomarkers may improve our ability to identify patients at highest risk for readmission or mortality before discharge. This will also allow resource allocation accordingly, while implementing strategies for personalized medicine based on the biomarker profile of the patient.
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Authors: Jeremiah R Brown; Devin M Parker; Meagan E Stabler; Marshall L Jacobs; Jeffrey P Jacobs; Allen D Everett; Kevin W Lobdell; Moritz C Wyler von Ballmoos; Heather Thiessen-Philbrook; Chirag Parikh; Todd Mackenzie; Anthony DiScipio; David Malenka; Michael E Matheny; Alexander Turchin; Donald S Likosky Journal: J Card Surg Date: 2021-09-02 Impact factor: 1.778