| Abstract | OBJECTIVES: The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). BACKGROUND: Given the hemodynamic, neurohormonal, and renal effects of natriuretic peptides, nesiritide might be useful in the management of patients undergoing cardiac surgery. METHODS: This prospective, double-blind, exploratory evaluation randomly assigned patients with ejection fraction </=40% who were undergoing CABG with anticipated use of CPB to receive either nesiritide or placebo, in addition to usual care, for 24 to 96 h after induction of anesthesia. Postoperative renal function, hemodynamics, and drug use (primary end points) were assessed in patients who underwent CABG using CPB; mortality and safety (secondary end points) were assessed in all patients who received the study drug. RESULTS: Of 303 randomized patients, 279 received the study drug and 272 underwent CABG using CPB. Compared with placebo, nesiritide was associated with a significantly attenuated peak increase in serum creatinine (0.15 +/- 0.29 mg/dl vs. 0.34 +/- 0.48 mg/dl; p < 0.001) and a smaller fall in glomerular filtration rate (-10.8 +/- 19.3 ml/min/1.73 m(2) vs. -17.2 +/- 21.9 ml/min/1.73 m(2); p = 0.001) during hospital stay or by study day 14, and a greater urine output (2,926 +/- 1,179 ml vs. 2,350 +/- 1,066 ml; p < 0.001) during the initial 24 h after surgery. In addition, nesiritide-treated patients had a shorter hospital stay (p = 0.043) and lower 180-day mortality (p = 0.046). CONCLUSIONS: Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival. (The NAPA Trial; ; ). |
| Authors | Robert M Mentzer Jr, Mehmet C Oz, Robert N Sladen, Allen H Graeve, Robert F Hebeler Jr, John M Luber Jr, Nicholas G Smedira, NAPA Investigators
(Affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. rmentzer at med.wayne.edu)
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| Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 49
Issue 6
Pg. 716-26
(Feb 13 2007)
ISSN: 1558-3597 United States |
| PMID | 17291938
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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| Chemical References |
- Natriuretic Agents
- Natriuretic Peptide, Brain
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| Topics |
- Adult
- Cardiac Surgical Procedures
- Cardiopulmonary Bypass
- Coronary Artery Bypass
- Double-Blind Method
- Female
- Heart Diseases
(physiopathology, surgery)
- Humans
- Male
- Middle Aged
- Natriuretic Agents
(therapeutic use)
- Natriuretic Peptide, Brain
(therapeutic use)
- Perioperative Care
- Prospective Studies
- Ventricular Dysfunction, Left
(drug therapy, physiopathology)
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