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J Thorac Cardiovasc Surg 2009;138:954-958
© 2009 The American Association for Thoracic Surgery

Perioperative Management

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, MDa, Mohamed A. Soliman Hamad, MDa,*, André J. van Zundert, MD, PhD, FRCAb,d, Elisabeth J. Martens, PhDc,e, Jacques P.A.M. Schönberger, MD, PhDa, Andre M. de Wolf, MD, PhDf

a Department of Cardio-Thoracic Surgery, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
b Department of Anesthesiology, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
c Department of Education and Research, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
d Department of Anesthesiology, University Hospital Ghent, Ghent, Belgium
e Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
f Department of Anesthesiology, The Feinberg School of Medicine, Northwestern University, Chicago, Ill

Received for publication December 10, 2008; revisions received March 23, 2009; accepted for publication March 29, 2009.

* Address for reprints: Mohamad A. Soliman Hamad, MD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, The Netherlands. (Email: aasmsn{at}cze.nl).

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






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