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Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery
Olli-Pekka Kangasniemi1, Fausto Biancari, Johannes Luukkonen
1Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland.
Insights
Elevated C-reactive protein (CRP) before coronary artery bypass grafting (CABG) surgery is linked to poorer long-term survival. Lowering CRP levels may improve outcomes for patients undergoing CABG.
Area of Science:
- Cardiology
- Biomarkers
- Surgical Outcomes
Background:
- C-reactive protein (CRP) is a marker for atherosclerosis and coronary event risk.
- Elevated CRP is associated with adverse cardiac events post-intervention.
Purpose of the Study:
- To determine the impact of preoperative C-reactive protein (CRP) levels on long-term outcomes in patients undergoing on-pump coronary artery bypass surgery (CABG).
Main Methods:
- Investigated 843 patients undergoing on-pump CABG.
- Analyzed the association between preoperative CRP levels and 12-year survival rates.
- Utilized multivariate analysis to identify independent predictors of mortality.
Main Results:
- Patients with preoperative CRP < 1.0 mg/dL had significantly better 12-year overall survival (74.1% vs 63.0%) and freedom from fatal cardiac events (86.7% vs 78.1%).
- Preoperative CRP ≥ 1.0 mg/dL was an independent predictor of late all-cause mortality (RR 1.60).
- The impact of CRP was more pronounced in patients with reduced left ventricular ejection fraction (<50%).
Conclusions:
- Increased preoperative C-reactive protein (CRP) levels are significantly associated with decreased overall survival following primary on-pump CABG.
- Preoperative CRP serves as a valuable prognostic marker for long-term outcomes after CABG.
Background:
Increased levels of C-reactive protein (CRP) are associated with the presence and severity of atherosclerosis, and with increased risk of coronary events as well as of cardiac events after coronary percutaneous intervention.
Methods:
We have investigated whether preoperative CRP had an impact on the long-term outcome of 843 patients who underwent on-pump coronary artery bypass surgery (CABG).
Results:
Among operative survivors, patients with preoperative CRP < 1.0 mg/dL had significantly better 12-year overall survival rate (74.1% vs 63.0%, p = 0.004) and survival freedom from fatal cardiac event (86.7% vs 78.1%). Multivariate analysis including patients' age, extracardiac arteriopathy, urgent/emergent operation, recent myocardial infarction, congestive heart failure, left ventricular ejection fraction, atrial fibrillation, transient ischemic attack/stroke, number of distal anastomoses, diabetes, and preoperative CRP > or = 1.0 mg/dL or <1.0 mg/dL, showed that the latter was an independent predictor of late all-cause mortality (p = 0.017, RR 1.60, 95% CI 1.09-2.35). Its impact on overall survival was particularly evident in patients with left ventricular ejection fraction <50% (CRP < 1.0 mg/dL: 58.7% vs CRP > or = 1.0 mg/dL: 43.7%, p < 0.00001).
Conclusions:
Increased preoperative levels of CRP are associated with significantly decreased overall survival after primary on-pump CABG.
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