title: Preoperative C-reactive protein and outcome after coronary artery bypass surgery.
abstract: BACKGROUND
  C-reactive protein (CRP) is a predictor of early and late outcome after coronary angioplasty, but there is scant data on its impact on the outcome after coronary artery bypass grafting (CABG).
  
  
  METHODS
  The predictive value of preoperative CRP was evaluated in a series of 764 patients who underwent on-pump CABG.
  
  
  RESULTS
  During the in-hospital stay, 13 patients (1.7%) died, 45 (4.5%) developed low cardiac output syndrome, and 28 (3.7%) suffered minor or major cerebrovascular complications. Patients with a preoperative serum concentration of CRP>/=1.0 mg/dL had a higher risk of overall postoperative death (5.3% vs 1.1%, p = 0.001), cardiac death (4.4% vs 0.8%, p = 0.002), low cardiac output syndrome (8.8% vs 3.7%, p = 0.01), and any cerebrovascular complication (4.4% vs 3.5%, p = 0.66). Preoperative serum concentration of CRP>/=1.0 mg/dL was significantly more frequent among patients with history of myocardial infarction, diabetes, lower limb ischemia, low left ventricular ejection fraction, NYHA class IV, and in those undergoing urgent or emergency operation. At multivariate analysis, preoperative serum concentration of CRP >/= 1.0 mg/dL (p = 0.01, O.R.: 6.97) and left ventricular ejection fraction (p = 0.01, O.R.: 0.95) were independent predictors of postoperative death. Postoperative mortality rate was 0.3% among patients with preoperative CRP < 1.0 mg/dL and an ejection fraction >/=50%, whereas it was 21.4% among those with a preoperative CRP >/= 1.0 mg/dL and an ejection fraction less than 50% (p < 0.0001).
  
  
  CONCLUSIONS
  Preoperative serum concentration of CRP in patients undergoing on-pump coronary artery bypass surgery is an important determinant of postoperative outcome.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: Samuli
authors.initials: S
authors.lastname: Lepojärvi
authors.forename: Pekka
authors.initials: P
authors.lastname: Rainio
authors.forename: Esa
authors.initials: E
authors.lastname: Salmela
authors.forename: Risto
authors.initials: R
authors.lastname: Pokela
authors.forename: Martti
authors.initials: M
authors.lastname: Lepojärvi
authors.forename: Jari
authors.initials: J
authors.lastname: Satta
authors.forename: Tatu S
authors.initials: TS
authors.lastname: Juvonen
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002303:Cardiac Output, Low / Q000209:etiology; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003327:Coronary Disease / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein