C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization.
BACKGROUND
Activation of the complement system after coronary artery bypass graft surgery involves C-reactive protein (CRP). This inflammatory response is related to baseline CRP levels and associated with postoperative arrhythmia, in particular atrial fibrillation (AF). We investigated whether baseline CRP levels are a risk indicator for the occurrence of AF and whether this phenomenon is cardiopulmonary bypass dependent.


METHODS
C-reactive protein was measured in perioperative blood samples of patients of the Octopus Study (coronary artery bypass graft surgery with [n = 73] or without cardiopulmonary bypass [n = 79]). Baseline CRP was dichotomized into a low and a high baseline group, using a cutoff value of 3.0 mg/L.


RESULTS
After coronary artery bypass graft surgery with cardiopulmonary bypass 11 of 53 patients (21%) with low preoperative CRP levels had AF versus 11 of 20 patients (55%) with high baseline CRP levels (p = 0.01). In the off-pump group AF occurred in 4 of 52 patients (8%) who had low baseline CRP levels, versus 8 of 27 patients (30%) with high preoperative CRP levels (p = 0.002). After adjusting for age, the odds ratio (95% confidence interval) was 4.6 (1.4 to 15.3) with cardiopulmonary bypass, 3.7 (0.93 to 14.7) in the off-pump group, and 3.3 (1.4 to 7.6) for both groups together. Continuous baseline CRP was an independent predictor for AF in a multivariate logistic regression model (p = 0.02).


CONCLUSIONS
Patients with high baseline CRP levels are at higher risk of having postoperative AF in both on-pump and off-pump surgery.
Lo
Bernard
B
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands. b.lo@azu.nl
Fijnheer
Rob
R
Nierich
Arno P
AP
Bruins
Peter
P
Kalkman
Cor J
CJ
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood; D011184:Postoperative Period
D015415:Biomarkers; D002097:C-Reactive Protein