High-sensitivity C-reactive Protein Predict Coronary Artery Bypass Surgery Near And Medium Term Prognosis

Background—Elevated C-reactive protein (CRP) is a powerful independent predictor of cardiovascular events in the healthy population and in patients with coronary artery disease. High-sensitive C-Reactive Protein (hsCRP) is precise and sensitive for quantification of CRP. But to date, there is no date on its impact on overall mid-term and late outcomes after coronary artery bypass grafting (CABG). The study objective was to evaluate the effect of hsCRP on early and mid-term outcome after CABGMethods—We have investigated the relationship of preoperative hsCRP with early and mid-term outcomes of all the patients who underwent isolated CABG between1st January2006and31st December2007in Fuwai Hospital. Then we tried to get an optimal cut off value of hsCRP for risk stratification and estimate the effect of elevated hsCRP on the early and mid-term outcomes by multivariable regression analysis. Early endpoints were in-hospital mortality and postoperative major morbidity. Mid-term endpoints were overall mortality, major adverse cardiovascular events (MACE) and new onset heart failure.Result—In2863of3236cases, the preoperative C-reactive protein level could be retrieved. During the in-hospital stay,26patients died (0.9%) and288patients suffered postoperative major morbidity (10.1%). Among operative survivors,11patients were unavailable for follow-up. At3.6year follow-up,56patients died (2.0%),105patients had MACE (3.7%) and70patients developed heart failure (2.5%). We found that every lmg/L uprising for hsCRP was associated with increased odds ratio (OR) for early mortality (OR=2.50, p=0.002), postoperative major morbidity (OR=1.38, p=0.02), and raised hazard ratio (HR) for mid-term mortality (HR=1.68, p=0.03), MACE (HR=1.48, p=0.04) and heart failure (HR=1.88,p=0.01). Further analysis showed that hsCRP=2.5mg/L was the best cutoff value for risk stratification in terms of both early and mid-term outcomes of CABG The patients whose preoperative hsCRP levels were elevated (>2.5mg/L, n=1070) suffered significantly increased early mortality (1.50%vs0.56%, p=0.01), major morbidity (12.71%vs8.48%, p<0.001), mid-term mortality (2.94%vs1.40%, p=0.01), MACE (5.12%vs2.86%,p=0.003) and heart failure (3.42%vs1.91%,p=0.02) than those whose preoperative hsCRP≤2.5mg/L (n=1793). Multivariate analysis revealed that preoperative hsCRP>2.5mg/L was an independent risk factor of both early (p=0.02, HR=2.55) and mid-term mortality (p=0.02, HR=1.92), postoperative major morbidity (p=0.004, HR=1.46), mid-term MACE (p<0.001, HR=2.06) and heart failure (p=0.03, HR=1.71).Conclusions—Preoperative hsCRP levels were significantly correlated with outcomes of CABG Elevated levels of hsCRP (>2.5mg/L) predict an increased risk of early and mid-term outcome after CABG. CRP levels should be taken into account for risk stratification in CABG. Background—Landmark clinical trials have demonstrated the prominent protective value of anti-inflammatory effect of statins on primary and secondary prevention of coronary artery diseases. In health people with average levels of total and LDL cholesterol, statins showed significant primary prevention effect for the group with elevated C reactive protein (CRP), but not for those without elevated CRP. However, no studies have addressed the issue that if patients with different inflammatory level might derive similar benefit from continuous statin treatment after coronary artery bypass grafting surgery (CABG). Therefore, we evaluated the effect of continuous statin treatment on late outcomes of patients with different CRP levels after CABG.Methods—This retrospective cohort study enrolled all the patients who underwent isolated CABG and survived to discharge between1st January2006and31st December2007in Fuwai Hospital, and was divided into two groups according to cut-off value of preoperative hsCRP (2.5mg/L) obtained in PART I. Then we evaluated the relations between postoperative continuous statin therapy and mid-term outcomes for both groups. Mid-term endpoints were overall mortality, major adverse cardiovascular events (MACE) and congestive heart failure.Result—According to PART I,2837patients were analyzed in this study. For the group of preoperative hsCRP>2.5mg/L, patients who took postoperative continuous statin therapy had remarkably reduced the mid-term incidences of death (0.74%vs5.28%,p<0.001), MACE (3.31%vs7.05%, p=0.003) and heart failure (2.03%vs4.89%, p=0.01) compared with those did not take persistent statins. For the group of preoperative hsCRP≤2.5mg/L, patients with postoperative continuous statin therapy had similar mid-term incidences of death (0.97%vs2.00%, p=0.10), MACE (3.29%vs2.27%, p=0.20) and heart failure (1.94%vs1.87%, p=0.98) compared with those did not take persistent statins. After adjusted for other variables, continuous statin therapy remarkably reduced risk of mid-term mortality by64%(HR=0.36,p=0.002,95%CI=0.25-0.70), MACE by54%(HR=0.46, p=0.01,95%CI=0.25-0.82) and heart failure by69%(HR=0.31,p=0.003, 95%CI=0.14-0.66) for patients with preoperative hsCRP>2.5mg/L. However, this protective effect was not statistically significant for mid-term mortality (HR=0.53,p=0.12,95%CI=0.24-1.18), MACE (HR=1.10, p=0.75,95%CI=0.60-2.04) and heart failure (HR=1.35,p=0.42,95%CI=0.65-2.82) among patients whose preoperative hsCRP≤2.5mg/L.Conclusions—Postoperative continuous statin therapy could significantly reduced the mid-term incidences of death, MACE, heart failure for patients with elevated preoperative levels of hsCRP(>2.5mg/L). Whereas, this protective effect was not statistically significant among patients whose preoperative levels of hsCRP≤2.5mg/L.