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C-reactive protein after coronary artery bypass graft surgery and its relationship with postoperative atrial
Oliver Juul Olesen1, Naja Emborg Vinding1, Lauge Østergaard1
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 3, 2100 København Ø, Denmark.
Insights
Elevated postoperative C-reactive protein (CRP) levels after coronary artery bypass graft (CABG) surgery are linked to a higher risk of developing postoperative atrial fibrillation (POAF). This finding highlights CRP as a potential indicator for POAF risk in CABG patients.
Area of Science:
- Cardiology
- Surgical Complications
- Inflammation Biomarkers
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass graft (CABG) surgery, increasing patient morbidity and mortality.
- Inflammation is implicated in POAF development, with preoperative C-reactive protein (CRP) levels showing a known association.
- The relationship between postoperative CRP levels and POAF risk remains less understood.
Purpose of the Study:
- To investigate the association between postoperative C-reactive protein (CRP) levels on postoperative day 4 and the incidence of postoperative atrial fibrillation (POAF).
- To determine if elevated CRP levels post-CABG surgery predict the development of POAF.
Main Methods:
- A cohort of 6711 patients undergoing first-time isolated CABG surgery between 2000 and 2016 was analyzed.
- Patients with no prior atrial fibrillation and available CRP measurements on postoperative day 4 were stratified into quartiles based on CRP levels.
- Multivariable logistic regression was employed to assess the association between CRP quartiles and POAF development.
Main Results:
- Patients in the highest CRP quartile (>175 mg/L) exhibited a higher incidence of POAF (35%) compared to the lowest quartile (≤90 mg/L) (25%).
- In adjusted analyses, the highest CRP group demonstrated significantly greater odds of developing POAF (OR 1.31; 95% CI 1.12-1.54) compared to the lowest CRP group.
- Patients in the highest CRP group were generally older and more frequently male.
Conclusions:
- Increased C-reactive protein (CRP) levels on postoperative day 4 following coronary artery bypass graft (CABG) surgery are significantly associated with an elevated risk of developing postoperative atrial fibrillation (POAF).
- Postoperative CRP may serve as a valuable biomarker for identifying patients at higher risk for POAF after CABG.
Aims:
Postoperative atrial fibrillation (POAF), a common complication following coronary artery bypass graft (CABG) surgery, is associated with increased morbidity and mortality. Inflammation may be an important factor for the pathogenesis of POAF, and increased preoperative levels of C-reactive protein (CRP) are associated with the development of POAF. However, the relationship between postoperative CRP and POAF is less well established.
Methods And Results:
Patients undergoing first-time isolated CABG surgery (1 January 2000-31 December 2016) were identified using the Eastern Danish Heart Surgery Database and nationwide administrative registries. Patients with no history of atrial fibrillation and with available CRP measurements from postoperative day (POD) 4 were included. The study population was divided into quartiles based on CRP. The association between CRP levels and the odds of developing POAF was investigated using multivariable logistic regression analysis. We included 6711 patients. The CRP intervals on POD 4 for the CRP groups (lowest to highest) were ≤90, >90 to ≤127, >127 to ≤175, and >175 mg/L, respectively. Patients in the highest CRP group were older and more often men compared with patients in the lowest CRP group [median age 67 years (P25-P75: 61-73) and 84.7% men vs. median age 64 years (P25-P75: 56-70) and 77.9% men]. In the lowest and highest CRP groups, 25% and 35% developed POAF, respectively. In adjusted analysis, the highest CRP group, compared with the lowest CRP group, was associated with greater odds of developing POAF (odds ratio 1.31; 95% confidence interval 1.12-1.54).
Conclusion:
Increased postoperative CRP levels after CABG surgery was associated with the development of POAF.
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