Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surge
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Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surgery Andrea De Lorenzo,1,2,3 Felipe Pittella,1 and Antonio Rocha1
Abstract—Increased C-reactive protein (CRP) is a predictor of cardiovascular risk, but its influence on outcomes after coronary artery bypass grafting surgery (CABG) is still incompletely studied. We studied the association between preoperative CRP and inhospital death after CABG. Patients with acute or chronic infectious or inflammatory disorders, autoimmune diseases, cancer, and prior cardiac surgery were excluded. Seventy-six patients were studied [27.6% with elevated CRP (>3 mg/l)]. Elevated CRP was more frequently found in patients who died than in those who survived (83.3% vs 17.1%, p=0.003); mean CRP levels were, respectively, 6.5±3.4 vs 2.4±3.5 mg/l (p=0.03). The hazard ratio of death was 11.7 for elevated CRP, and the ROC curve for the discrimination of death with CRP had an area under the curve of 0.82. An improvement to mortality risk prediction following CABG may be offered by the preoperative analysis of CRP. KEY WORDS: C-reactive protein; coronary artery disease; coronary artery bypass surgery.
increased preoperative CRP levels have also been shown to be associated with increased short- and long-term morbidity and mortality. Many of these studies, however, have been retrospective analyses in which the presence of infectious or inflammatory disorders could not be ascertained, patients with recent acute coronary syndromes were included, the definitions of postoperative major adverse cardiovascular events included “soft” events such as repeat revascularization, or cardiac surgical procedures were mixed [8–14]. To address these gaps in knowledge, we aimed to prospectively study stable patients with coronary artery disease (CAD) and without other diseases that might increase CRP levels, undergoing elective, isolated coronary artery bypass grafting (CABG) surgery, in order to investigate the association between elevated preoperative CRP levels and inhospital post-CABG death.
INTRODUCTION The role of C-reactive protein (CRP) in the pathophysiology of atherosclerosis and cardiovascular disease has been a matter of interest for the past three decades. CRP is a nonspecific acute phase reactant which is synthesized by the liver, and whose production increases in response to a variety of systemic conditions such as infection, trauma, cancer, or autoimmune inflammatory diseases. In the case of atherosclerosis, a number of cytokines which are produced when macrophages are converted into lipidladen foam cells stimulate CRP production [1, 2]. CRP has been shown to be a predictor of cardiac events in nonsurgical populations, constituted either of apparently healthy individuals or of patients with acute or chronic coronary artery disease [3–6]. CRP values of >3 mg/l have been used as the threshold above which cardiovascular risk is believed to be increased [7]. In cardiac surgical patients,
METHODS 1
Coronary Artery Disease Department, Natio
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