Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: A prospective observational study

Abstract

C-reactive protein is a powerful independent predictor of cardiovascular events in patients with coronary artery disease. The relation between C-reactive protein (CRP) concentration and in-hospital outcome, after coronary artery bypass grafting (CABG), has not yet been established. The study aims to evaluate the predictive value of pre-operative CRP for in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP (hs-CRP) levels were measured pre-operatively on the day of surgery in 66 patients scheduled for elective on pump CABG surgery. Post-operative cardiovascular events such as death from cardiovascular causes, ischemic stroke, myocardial damage, myocardial infarction and low output heart failure were recorded. During the first 30 days after surgery, 54 patients were free from observed events and 14 developed the following cardiovascular events: 10 (15%) had myocardial damage, four (6%) had low output heart failure and two (3%) suffered stroke. No patients died during the follow-up period. Serum concentration of hs-CRP > or = 3.3 mg/l (cut-off point obtained by ROC analysis) was related to higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01), myocardial damage (24% vs 6%, P = 0.04) and low output heart failure (12% vs 0%, P = 0.04). Multivariate logistic regression analysis showed that hs-CRP > or = 3.3 mg/l ( P = 0.002, O.R.: 19.3 (95% confidence interval (CI) 2.9-128.0)), intra-operative transfusion of red blood cells ( P = 0.04, O.R.: 9.9 (95% C.I. 1.1-85.5)) and absence of diuretics in daily antihypertensive treatment ( P = 0.02, O.R.: 15.1 (95% C.I. 1.4-160.6) were independent predictors of combined cardiovascular event. Patients having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an increased risk of post-operative cardiovascular events after on pump coronary artery bypass grafting surgery.

Trimetazidina e resposta inflamatória em cirurgia de revascularização do miocárdio

“…This draws attention to studies relating high pre-operative levels of inflammatory markers to post-operative complications, suggesting that those levels should be normal prior to surgery 12,13 .…”

“…Mezzomo et al 32 , studying patients who had undergone CABG-ECC, have concluded that pre-operative HS-CRP levels over 3 mg/L were an independent predictor of post-operative respiratory infection. Balciunas et al 13 , in a prospective study, have reported that CRP is a predictor of post-operative complications when serum levels over 3.3 mg/L are achieved. In the present study, no post-operative complications were observed in the groups during the followup period until hospital discharge (15 days).…”

C-Reactive Protein is not an Independent Risk Factor for Ventricular Thrombus

“…18 In the recent past investigators like Biancari and Balciunas. 9,19 have linked high levels of preoperative hs-CRP with adverse cardiovascular events after coronary bypass grafting surgery whereas authors like Gaudino refuted this claim in their clinical observations. 1 Moreover even if such a link is valid for prothrombotic effects of CRP its molecular mechanism is controversial.…”

Plasma Monocyte Chemotactic Protein-1 Is Associated With Acute Kidney Injury and Death After Cardiac Operations

“…Pre- and intraoperative inflammation is recognized as an important predictor of postoperative complications after cardiac surgery(4,5). Preoperative inflammation primes the kidney and other organs for intraoperative injury, and elevations of preoperative inflammatory markers are associated with adverse postoperative outcomes.…”