Preoperative C-reactive protein and outcome after coronary artery bypass surgery.
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.
Biancari
Fausto
F
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
Lahtinen
Jarmo
J
Lepojärvi
Samuli
S
Rainio
Pekka
P
Salmela
Esa
E
Pokela
Risto
R
Lepojärvi
Martti
M
Satta
Jari
J
Juvonen
Tatu S
TS
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
D002097:C-Reactive Protein