title: Preoperative values of inflammatory markers predict clinical outcomes in patients after CABG, regardless of the use of cardiopulmonary bypass.
abstract: OBJECTIVE
  The impact of systemic inflammation on clinical outcomes after CABG surgery is still controversial. In this study, we evaluated the impact of the markers of inflammation, endothelial damage and platelet activation on clinical outcomes after on- and off-pump CABG.
  
  
  METHODS
  A group of 191 consecutive on- and off-pump CABG patients were prospectively studied. Blood samples were drawn before surgery, 18-36h after the procedure and 5-7 days postoperatively and analyzed for 8-iso-prostaglandin F2α(8-iso-PGF2α), asymmetric dimethylarginine (ADMA) and β-thromboglobulin (β-TG). White blood count and C-reactive protein were measured twice, first before and then during the first 18-36h after CABG. The primary clinical end-points were: low cardiac output syndrome (LCOS), postoperative myocardial infarction (PMI) and in-hospital cardiovascular death.
  
  
  RESULTS
  Elevation of 8-iso-PGF2α, ADMA and β-TG before surgery was associated with an increased risk of morbidity and mortality after CABG. There were no differences in analyzed markers and clinical outcomes between the on- and off-pump groups. Even during the uncomplicated postoperative course the inflammatory response was enhanced and still remained higher than baseline 5-7 days after surgery.
  
  
  CONCLUSIONS
  Links between preoperative 8-iso-PGF2α, ADMA and β-TG and unfavorable early post-CABG outcomes suggest that these markers could be useful in identifying patients with increased risk of LCOS, PMI and in-hospital cardiovascular death following elective CABG.
authors.affiliation: Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland. Electronic address: plicner@pro.onet.pl.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wąsowicz
authors.affiliation: Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland.
authors.forename: Bugusław
authors.initials: B
authors.lastname: Gawęda
authors.affiliation: Department of Anesthesia, John Paul II Hospital, Krakow, Poland.
authors.forename: Hubert
authors.initials: H
authors.lastname: Hymczak
authors.affiliation: Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Kapelak
authors.affiliation: Department of Anesthesia, John Paul II Hospital, Krakow, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000601:surgery*; D015237:Dinoprost / Q000031:analogs & derivatives / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D001620:beta-Thromboglobulin / Q000378:metabolism
chemical_list: D015415:Biomarkers; C061615:PPBP protein, human; D001620:beta-Thromboglobulin; C075750:8-epi-prostaglandin F2alpha; D002097:C-Reactive Protein; D015237:Dinoprost
keywords: Cardiopulmonary bypass; Coronary artery bypass grafting; Inflammation