Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: Eight years of follow-up

van Straten, Albert H.M.; Soliman Hamad, Mohamed A.; van Zundert, André J.; Martens, Elisabeth J.; Schönberger, Jacques P.A.M.; de Wolf, Andre M.

doi:10.1016/j.jtcvs.2009.03.050

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 954-958, October 2009

Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: Eight years of follow-up

Albert H.M. van Straten, MD
- Department of Cardio-Thoracic Surgery, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
Mohamed A. Soliman Hamad, MD
- Department of Cardio-Thoracic Surgery, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
- Address for reprints: Mohamad A. Soliman Hamad, MD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.
André J. van Zundert, MD, PhD, FRCA
- Department of Anesthesiology, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
- Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium
Elisabeth J. Martens, PhD
- Department of Education and Research, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
Jacques P.A.M. Schönberger, MD, PhD
- Department of Cardio-Thoracic Surgery, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
Andre M. de Wolf, MD, PhD
- Department of Anesthesiology, The Feinberg School of Medicine, Northwestern University, Chicago, Ill

Received 10 December 2008; received in revised form 23 March 2009; accepted 29 March 2009. published online 24 June 2009.

Objective

There is limited evidence that increased preoperative levels of C-reactive protein are associated with increased mortality after coronary artery bypass grafting. We retrospectively investigated in 5669 patients the predictive value of preoperative C-reactive protein levels for early and late mortalities after coronary artery bypass grafting.

Methods

Patients undergoing isolated coronary artery bypass grafting between January 2000 and December 2007 (n = 8500) were studied. Preoperative demographic data and risk factors and outcome data (mortality data) were prospectively collected in a database. Preoperative C-reactive protein levels were retrieved from the laboratory data.

Results

In 5669 of 8500 cases, the preoperative C-reactive protein level could be retrieved. Seventy-five patients were unavailable for follow-up. A preoperative C-reactive protein level greater than 10 mg/L was an independent risk factor for early mortality, whereas a level greater than 5 mg/L was a risk factor for late mortality. Other risk factors were age, sex, chronic obstructive pulmonary disease, diabetes, left ventricular ejection fraction less than 35%, peripheral vascular disease, and previous cardiac surgery. We found a higher mean C-reactive protein value in patients with a left ventricular ejection fraction less than 35% (18.5 ± 33 mg/L) than in those with an ejection fraction greater than 35% (P < .0001).

Conclusions

Preoperative C-reactive protein levels can be used in risk stratification in coronary artery bypass grafting surgery. A C-reactive protein level greater than 10 mg/L is a risk factor for early mortality, whereas a level greater than 5 mg/L is a risk factor for late mortality.

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, COPD, chronic obstructive pulmonary disease, CRP, C-reactive protein, LVEF, left ventricular ejection fraction, PVD, peripheral vascular disease