Impact of Preoperative C-Reactive Protein on Midterm Outcomes after Off-Pump Coronary Artery Bypass Grafting

Abstract

Background We aimed to assess the impact of C-reactive protein (CRP) on clinical outcomes after off-pump coronary artery bypass grafting (OPCABG).

Methods Seven hundred fifty-five consecutive OPCABG patients were divided into two groups according to their preoperative CRP level (normal CRP [NCRP] group [CRP ≤ 6.0 mg/L] versus high CRP [HCRP] group [CRP > 6.0 mg/L]). Outcome measurements were cardiac death and major adverse cardiac and cerebrovascular event (MACCE).

Results Early mortality was higher in the HCRP group (p = 0.036). During follow-up, cardiac mortality was 1.2% in the NCRP group and 7.1% in the HCRP group (p < 0.001). The overall MACCE incidence was 11.2% in the NCRP group and 16.5% in the HCRP group (p = 0.042). All-cause mortality was the only determining factor (p < 0.001), whereas the incidences of myocardial infarction, stroke, and repeat revascularization were similar between the two groups (p = 0.987, p = 0.201, p = 0.426). The 3-year freedom rates from cardiac death and MACCE were 98.8 ± 0.5% and 87.5 ± 1.6% in the NCRP group and 92.5 ± 1.7% and 84.3 ± 2.5% in the HCRP group (p < 0.001, p = 0.09, respectively).

Conclusions Patients with HCRP level showed worse clinical outcomes regarding cardiac death and MACCE after OPCABG.

Keywords

coronary artery bypass surgery - off-pump - C-reactive protein

• References

• 1 Kaptoge S, Di Angelantonio E, Pennells L , et al; Emerging Risk Factors Collaboration. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med 2012; 367 (14) 1310-1320
• 2 Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151 (7) 483-495
• 3 Danesh J, Wheeler JG, Hirschfield GM , et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med 2004; 350 (14) 1387-1397
• 4 Tousoulis D, Papageorgiou N, Stefanadis C. Is C-reactive protein a prognostic marker after angioplasty?. Heart 2009; 95 (12) 957-959
• 5 Walter DH, Fichtlscherer S, Sellwig M, Auch-Schwelk W, Schächinger V, Zeiher AM. Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation. J Am Coll Cardiol 2001; 37 (3) 839-846
• 6 Biancari F, Lahtinen J, Lepojärvi S , et al. Preoperative C-reactive protein and outcome after coronary artery bypass surgery. Ann Thorac Surg 2003; 76 (6) 2007-2012
• 7 Kangasniemi O-P, Biancari F, Luukkonen J , et al. Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery. Eur J Cardiothorac Surg 2006; 29 (6) 983-985
• 8 van Straten AHM, Soliman Hamad MA, van Zundert AJ, Martens EJ, Schönberger JP, de Wolf AM. Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: eight years of follow-up. J Thorac Cardiovasc Surg 2009; 138 (4) 954-958
• 9 van der Harst P, Voors AA, Volbeda M, Buikema H, van Veldhuisen DJ, van Gilst WH. Usefulness of preoperative C-reactive protein and soluble intercellular adhesion molecule-1 level for predicting future cardiovascular events after coronary artery bypass grafting. Am J Cardiol 2006; 97 (12) 1697-1701
• 10 Perry TE, Muehlschlegel JD, Liu KY , et al; CABG Genomics Investigators. Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology 2010; 112 (3) 607-613
• 11 Hedman A, Larsson PT, Alam M, Wallen NH, Nordlander R, Samad BA. CRP, IL-6 and endothelin-1 levels in patients undergoing coronary artery bypass grafting. Do preoperative inflammatory parameters predict early graft occlusion and late cardiovascular events?. Int J Cardiol 2007; 120 (1) 108-114
• 12 Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69 (4) 1198-1204
• 13 Yin WH, Chen JW, Jen HL , et al. Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure. Am Heart J 2004; 147 (5) 931-938
• 14 Cappabianca G, Paparella D, Visicchio G , et al. Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery. Ann Thorac Surg 2006; 82 (6) 2170-2178
• 15 Raja SG, Berg GA. Impact of off-pump coronary artery bypass surgery on systemic inflammation: current best available evidence. J Card Surg 2007; 22 (5) 445-455
• 16 Momin A, Melikian N, Wheatcroft SB , et al. The association between saphenous vein endothelial function, systemic inflammation, and statin therapy in patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg 2007; 134 (2) 335-341