Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Abstract

Background: Serum alkaline phosphatase (ALP) is related to vascular calcification. In a recent study on percutaneous coronary intervention (PCI) with a drug-eluting stent, higher ALP was associated with poor clinical outcomes in terms of mortality, myocardial infarction, and stent thrombosis. The aim of this study was to evaluate the relationship between preoperative ALP and clinical outcome of off-pump coronary artery bypass surgery (OPCAB). Methods and Results:We retrospectively enrolled and reviewed a total of 1,335 patients who underwent OPCAB. Patients were divided into tertiles based on preoperative serum ALP (<60, 60-76, and >76 IU/L). As preoperative ALP increased, the HR of mortality remained constant after adjusting for confounders. On Cox proportional hazards regression analysis, there was no association between ALP and all-cause mortality. The adjusted HR for all-cause mortality for the middle tertile was 0.882 (95% CI: 0.592-1.314, P=0.537), and 0.915 (95% CI: 0.605-1.383, P=0.672) for the highest tertile. In addition, no associations between ALP and cardiovascular mortality, myocardial infarction, revascularization, or major adverse cardiac events were found.Conclusions: Unlike after PCI, high ALP is not related to adverse clinical events, such as mortality, myocardial infarction, or revascularization after OPCAB. ALP might be considered when determining the optimal revascularization technique.

Clinically-defined preoperative serum phosphorus abnormalities and outcomes of coronary artery bypass grafting: Retrospective analysis using inverse probability weighting adjustment

“…This result corresponds with the findings of a recent study on CABG [13]. The suggested explanation was that diseased arteries are fully replaced by endothelialized arteries or vein grafts in CABG, in contrast to other cardiovascular disease or coronary interventions, and so vascular calcification biomarkers are relatively useless in predicting outcomes [13]. On the other hand, in this study, hypophosphatemia appeared to be associated with all-cause death in multivariate analysis.…”

“…The relationship between serum phosphorus level and vascular calcification has been established based on a large body of evidence [2], and serum phosphorus abnormalities have been implicated in cardiovascular mortality and calcification of coronary arteries [4,5]. However, previous studies of patients undergoing coronary revascularization have shown inconsistent results [11–13]. Interestingly, all of these studies stratified patients into multiple groups in a graded manner by applying discrete criteria within normal range.…”

“…In addition to the well-known adverse effects of serum phosphorus abnormalities, an increase in morbidity after cardiovascular surgeries has also been reported [8–10]. However, in contrast to the results of percutaneous coronary intervention [11,12], previous studies have shown an inconsistent relationship between serum phosphorus abnormalities and coronary artery bypass grafting (CABG) outcomes [8,13]. In addition, to the best of our knowledge, no prior studies have used the clinical criteria definition of phosphorus abnormalities to perform a direct three-group comparison of the outcomes of CABG among normal, hypo- and hyperphosphatemia groups.…”

Increased Serum Parathyroid Hormone, Osteocalcin and Alkaline Phosphatase Are Associated with a Long-Term Adverse Cardiovascular Outcome after Coronary Artery Bypass Graft Surgery

“…Opposite to PTH, an association of serum osteocalcin with cardiovascular death is unclear, being U-shaped as well as gender-and age-dependent [31][32][33]. Data regarding the prognostic significance of alkaline phosphatase are also contradictory, varying between revascularisation modalities [34][35][36]. Albeit serum alkaline phosphatase may be also increased in patients with stroke, chronic heart failure, arterial hypertension, type 2 diabetes mellitus, and obesity, a number of studies showed its usefulness as a prognostic indicator during the long-term follow-up of patients with coronary artery disease [35,36] including those with ST-segment elevation MI [37].…”

Prognostic impact of preoperative serum alkaline phosphatase level on a composite of morbidity and mortality after thoracic endovascular aortic repair

“…[16] However, serum ALP level did not have a prognostic value for predicting adverse outcomes such as major adverse cardiac events, mortality, MI, or revascularization after off-pump coronary artery bypass surgery. [34] This discrepancy may be due to the different inflammatory process between PCI and open cardiac surgery. As serum ALP level was reported to reflect inflammation, a different inflammatory process may be an important factor for predicting adverse outcomes by using serum ALP level.…”