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Published in: Inflammation 3/2012

01-06-2012

Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surgery

Authors: Andrea De Lorenzo, Felipe Pittella, Antonio Rocha

Published in: Inflammation | Issue 3/2012

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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.
Literature
1.
go back to reference Ross, R. 2004. Atherosclerosis is an inflammatory disease: Implications for therapy. The New England Journal of Medicine 9: 2764–2777. Ross, R. 2004. Atherosclerosis is an inflammatory disease: Implications for therapy. The New England Journal of Medicine 9: 2764–2777.
2.
go back to reference Tzoulaki, I., G.D. Murray, A.J. Lee, A. Rumley, G.D. Lowe, and F.G. Fowkes. 2005. C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh Artery Study. Circulation 112: 976–983.PubMedCrossRef Tzoulaki, I., G.D. Murray, A.J. Lee, A. Rumley, G.D. Lowe, and F.G. Fowkes. 2005. C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh Artery Study. Circulation 112: 976–983.PubMedCrossRef
3.
go back to reference Ridker, P.M., and N. Cook. 2004. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham risk scores. Circulation 109: 1955–1959.PubMedCrossRef Ridker, P.M., and N. Cook. 2004. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham risk scores. Circulation 109: 1955–1959.PubMedCrossRef
4.
go back to reference Danesh, J., J.G. Wheeler, G.M. Hirschfield, S. Eda, G. Eiriksdottir, A. Rumley, G.D. Lowe, et al. 2004. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. The New England Journal of Medicine 350: 1387–1397.PubMedCrossRef Danesh, J., J.G. Wheeler, G.M. Hirschfield, S. Eda, G. Eiriksdottir, A. Rumley, G.D. Lowe, et al. 2004. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. The New England Journal of Medicine 350: 1387–1397.PubMedCrossRef
5.
go back to reference Dhingra, R., P. Gona, B.H. Nam, R.B. D’Agostino Sr., P.W. Wilson, E.J. Benjamin, and C.J. O'Donnell. 2007. C-reactive protein, inflammatory conditions, and cardiovascular disease risk. American Journal of Medicine 120: 1054–1062.PubMedCrossRef Dhingra, R., P. Gona, B.H. Nam, R.B. D’Agostino Sr., P.W. Wilson, E.J. Benjamin, and C.J. O'Donnell. 2007. C-reactive protein, inflammatory conditions, and cardiovascular disease risk. American Journal of Medicine 120: 1054–1062.PubMedCrossRef
6.
go back to reference Lindahl, B., H. Toss, A. Siegbahn, P. Venge, and L. Wallentin. 2000. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. The New England Journal of Medicine 343: 1139–1147.PubMedCrossRef Lindahl, B., H. Toss, A. Siegbahn, P. Venge, and L. Wallentin. 2000. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. The New England Journal of Medicine 343: 1139–1147.PubMedCrossRef
7.
go back to reference Pearson, T.A., G.A. Mensah, R.W. Alexander, J.L. Anderson, R.O. Cannon 3rd, M. Criqui, et al. 2003. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107: 499–511.PubMedCrossRef Pearson, T.A., G.A. Mensah, R.W. Alexander, J.L. Anderson, R.O. Cannon 3rd, M. Criqui, et al. 2003. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107: 499–511.PubMedCrossRef
8.
go back to reference Gaudino, M., G. Nasso, F. Andreotti, G. Minniti, L. Iacoviello, M.B. Donati, et al. 2002. Preoperative C-reactive protein level and outcome following coronary surgery. European Journal of Cardiovascular Surgey 22: 521–526.CrossRef Gaudino, M., G. Nasso, F. Andreotti, G. Minniti, L. Iacoviello, M.B. Donati, et al. 2002. Preoperative C-reactive protein level and outcome following coronary surgery. European Journal of Cardiovascular Surgey 22: 521–526.CrossRef
9.
go back to reference Biancari, F., J. Lahtinen, S. Lepojarvi, P. Rainio, E. Salmela, R. Pokela, et al. 2003. Preoperative C-reactive protein and outcome after coronary artery bypass surgery. The Annals of Thoracic Surgery 76: 2007–2012.PubMedCrossRef Biancari, F., J. Lahtinen, S. Lepojarvi, P. Rainio, E. Salmela, R. Pokela, et al. 2003. Preoperative C-reactive protein and outcome after coronary artery bypass surgery. The Annals of Thoracic Surgery 76: 2007–2012.PubMedCrossRef
10.
go back to reference Cappabianca, G., D. Paparella, G. Visicchio, G. Capone, G. Lionettei, F. Numis, et al. 2006. Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery. The Annals of Thoracic Surgery 82: 2170–2178.PubMedCrossRef Cappabianca, G., D. Paparella, G. Visicchio, G. Capone, G. Lionettei, F. Numis, et al. 2006. Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery. The Annals of Thoracic Surgery 82: 2170–2178.PubMedCrossRef
11.
go back to reference Kangasniemi, O.P., F. Biancari, Luukkonen, S. Vuorisalo, J. Satta, R. Pokela, et al. 2006. Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery. European Journal of Cardiovascular Surgey 29: 983–985.CrossRef Kangasniemi, O.P., F. Biancari, Luukkonen, S. Vuorisalo, J. Satta, R. Pokela, et al. 2006. Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery. European Journal of Cardiovascular Surgey 29: 983–985.CrossRef
12.
go back to reference Kim, D.H., J.K. Shim, S.W. Hong, K.R. Cho, S.Y. Kang, and Y.L. Kwak. 2009. Predictive value of C-reactive protein for major postoperative complications following off-pump coronary artery bypass surgery: Prospective and observational trial. Circulation Journal 73: 872–877.PubMedCrossRef Kim, D.H., J.K. Shim, S.W. Hong, K.R. Cho, S.Y. Kang, and Y.L. Kwak. 2009. Predictive value of C-reactive protein for major postoperative complications following off-pump coronary artery bypass surgery: Prospective and observational trial. Circulation Journal 73: 872–877.PubMedCrossRef
13.
go back to reference Xu, L., L. Xiao-hui, N. Shao-ping, D. Xin, L. Qiang, K. Jun-ping, et al. 2010. Prognostic value of baseline C-reactive protein levels in patients undergoing coronary revascularization. Chinese Medical Journal 123(13): 1628–1632. Xu, L., L. Xiao-hui, N. Shao-ping, D. Xin, L. Qiang, K. Jun-ping, et al. 2010. Prognostic value of baseline C-reactive protein levels in patients undergoing coronary revascularization. Chinese Medical Journal 123(13): 1628–1632.
14.
go back to reference Perry, T.E., J.D. Muehlschlegel, K. Liu, A.A. Fox, C.D. Collard, S.C. Body, and CABG Genomics Investigators. 2010. Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology 112: 607–613.PubMedCrossRef Perry, T.E., J.D. Muehlschlegel, K. Liu, A.A. Fox, C.D. Collard, S.C. Body, and CABG Genomics Investigators. 2010. Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology 112: 607–613.PubMedCrossRef
15.
go back to reference National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. 2002. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106: 3143–3421. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. 2002. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106: 3143–3421.
16.
go back to reference Currie, C.J., C.D. Poole, and P. Conway. 2008. Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality. Heart 94: 457–462.PubMedCrossRef Currie, C.J., C.D. Poole, and P. Conway. 2008. Evaluation of the association between the first observation and the longitudinal change in C-reactive protein, and all-cause mortality. Heart 94: 457–462.PubMedCrossRef
17.
go back to reference Hamer, M., Y. Chida, and E. Stamakis. 2010. Association of very highly elevated C-reactive protein concentration with cardiovascular events and all-cause mortality. Clinical Chemistry 56: 132–135.PubMedCrossRef Hamer, M., Y. Chida, and E. Stamakis. 2010. Association of very highly elevated C-reactive protein concentration with cardiovascular events and all-cause mortality. Clinical Chemistry 56: 132–135.PubMedCrossRef
18.
go back to reference Bisoendial, R.J., S.M. Boekholdt, M. Vergeer, E.S.G. Stroes, and J.J.P. Kastelein. 2010. C-reactive protein is a mediator of cardiovascular disease. European Heart Journal 31: 2087–2095.PubMedCrossRef Bisoendial, R.J., S.M. Boekholdt, M. Vergeer, E.S.G. Stroes, and J.J.P. Kastelein. 2010. C-reactive protein is a mediator of cardiovascular disease. European Heart Journal 31: 2087–2095.PubMedCrossRef
19.
go back to reference Anand, S.A., and S. Yusuf. 2010. C-reactive protein is a bystander of cardiovascular disease. European Heart Journal 31: 2092–2097.PubMedCrossRef Anand, S.A., and S. Yusuf. 2010. C-reactive protein is a bystander of cardiovascular disease. European Heart Journal 31: 2092–2097.PubMedCrossRef
20.
go back to reference Balciunas, M., L. Bagdonaite, R. Samalavicius, L. Griskevicius, and A. Vuylsteke. 2009. Preoperative high-sensitivity C reactive protein predicts coronary events after coronary artery bypass grafting surgery: A prospective observational study. Annals of Cardiac Anaesthesia 12: 127–132.PubMedCrossRef Balciunas, M., L. Bagdonaite, R. Samalavicius, L. Griskevicius, and A. Vuylsteke. 2009. Preoperative high-sensitivity C reactive protein predicts coronary events after coronary artery bypass grafting surgery: A prospective observational study. Annals of Cardiac Anaesthesia 12: 127–132.PubMedCrossRef
21.
go back to reference Henriksson, M., S. Palmer, R. Chen, J. Damant, N.K. Fitzpatrick, K. Abrams, et al. 2010. Assessing the cost effectiveness of using prognostic biomarkers with decision models: Case study in prioritising patients waiting for coronary artery surgery. BMJ 340: b5606.PubMedCrossRef Henriksson, M., S. Palmer, R. Chen, J. Damant, N.K. Fitzpatrick, K. Abrams, et al. 2010. Assessing the cost effectiveness of using prognostic biomarkers with decision models: Case study in prioritising patients waiting for coronary artery surgery. BMJ 340: b5606.PubMedCrossRef
22.
go back to reference Pepys, M.B., G.M. Hirschfield, G.A. Tennent, J.R. Gallimore, M.C. Kahan, V. Bellotti, et al. 2006. Targeting C-reactive protein for the treatment of cardiovascular disease. Nature 440: 1217–1221.PubMedCrossRef Pepys, M.B., G.M. Hirschfield, G.A. Tennent, J.R. Gallimore, M.C. Kahan, V. Bellotti, et al. 2006. Targeting C-reactive protein for the treatment of cardiovascular disease. Nature 440: 1217–1221.PubMedCrossRef
23.
go back to reference Ridker, P.M., E. Danielson, F.A.H. Fonseca, J. Genest, A.M. Gotto Jr., J.J. Kastelein, et al. 2008. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. The New England Journal of Medicine 359: 2195–2207.PubMedCrossRef Ridker, P.M., E. Danielson, F.A.H. Fonseca, J. Genest, A.M. Gotto Jr., J.J. Kastelein, et al. 2008. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. The New England Journal of Medicine 359: 2195–2207.PubMedCrossRef
Metadata
Title
Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surgery
Authors
Andrea De Lorenzo
Felipe Pittella
Antonio Rocha
Publication date
01-06-2012
Publisher
Springer US
Published in
Inflammation / Issue 3/2012
Print ISSN: 0360-3997
Electronic ISSN: 1573-2576
DOI
https://doi.org/10.1007/s10753-011-9426-1

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