Plasma Corin Decreases After Coronary Artery Bypass Graft Surgery and Is Associated With Postoperative Heart Failure: A Pilot Study

Abstract

Objective: Corin is a natriuretic peptide-converting enzyme that cleaves precursor pro-B-type natriuretic peptide to active B-type natriuretic peptide (BNP) (diuretic, natriuretic, and vaso- dilatory properties). Increased plasma BNP is a known diag- nostic and prognostic heart failure (HF) biomarker in ambulatory and surgical patients. Recent studies indicate that plasma corin is decreased significantly in chronic HF patients, yet perioper- ative plasma corin concentrations have not been assessed in cardiac surgical patients. The objectives of this study were to determine the effect of coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) on plasma corin concentrations and to assess the association between change in perioperative plasma corin concentration and long-term postoperative HF hospitalization or death. It was hypothesized that plasma corin concentrations decrease significantly from preoperative baseline during postoperative days 1 to 4 and that hospitalization or death from HF during the 5 years after surgery is associated with higher relative difference (preoperative base- line to postoperative nadir) in plasma corin concentrations. Design: Prospective observational pilot study. Setting: Two institutions: Brigham and Women’s Hospi- tal, Boston, Massachusetts and the Texas Heart Institute, St. Luke’s Hospital, Houston, Texas. Participants: 99 patients of European ancestry who under- went isolated primary CABG surgery with CPB. Interventions: Nonemergency isolated primary CABG sur- gery with CPB. Measurements and Main Results: Plasma corin concen- tration was assessed preoperatively and at 4 postoperative time points (postoperative days 1-4). HF hospitalization or HF death events during the 5 years after surgery were identified by review of hospital and death records. Post- operative plasma corin concentrations were significantly lower than preoperative baseline concentrations (p o 0.0001). Perioperative corin concentrations were sig- nificantly higher in males than in females (p o 0.0001). Fifteen patients experienced long-term postoperative HF events. Patients who experienced HF hospitalization or HF death during study follow-up had significantly higher rela- tive difference in plasma corin concentration (preoperative baseline to postoperative nadir) than patients who did not experience HF events during study follow-up (p 1⁄4 0.03). Conclusions: Plasma corin concentrations decrease signif- icantly from preoperative concentrations after CABG sur- gery. HF hospitalization or HF death during the 5 years after CABG surgery with CPB is associated with larger relative decrease in plasma corin concentration from preoperative baseline. Further investigation is warranted to determine the role of corin in postoperative HF biology.