Elevated B-type natriuretic peptide is associated with increased in-hospital mortality or cardiac arrest in patients undergoing implantable cardioverter-defibrillator implantation

Background: The implantable cardioverter-defibrillator (ICD) is the most effective treatment for preventing arrhythmic deaths in patients with heart failure, but periprocedural complications, including in-hospital mortality or cardiac arrest, may occur, and little is known about risk factorsWe asked whether elevated B-type natriuretic peptide (BNP) level is associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implantationMethods and Results: From the National Cardiovascular Data Registry ICD Registry, we identified 53 198 patients who received ICD implants and underwent preoperative BNP measurement from 2006 to 2008The patients were categorized into 4 groups by BNP levels (<100, 100 to <300, 300 to <1000, and ≥1000 pg/mL)Complication rates were compared among groups, and odds ratios for in-hospital mortality or cardiac arrest were estimated by multiple hierarchical logistic regressionsThere were 2952 complications reported, including 510 in-hospital deaths and 365 cardiac arrestsThe rate of in-hospital mortality or cardiac arrest significantly increased with elevated BNP level (P<0.001)The adjusted odds ratios of in-hospital mortality or cardiac arrest were statistically significant in all 3 higher BNP groups [odds ratio (95% CI), 1.99 (1.17 to 3.39), 2.49 (1.50 to 4.13), and 4.25 (2.57 to 7.06) in the second, third, and fourth groups using <100 as reference]Among subgroups, the association was more significant in men, patients with renal dysfunction, and patients undergoing biventricular ICD implantationConclusions: Elevated BNP level was significantly associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implantStrategies aimed at reducing preprocedural BNP or creating systems to manage procedural risk merit further investigation.