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Eur J Cardiothorac Surg 2007;31:685-690. doi:10.1016/j.ejcts.2006.12.029
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Preoperative C-reactive protein levels predict 9-month mortality after coronary artery bypass grafting surgery for the treatment of left main coronary artery stenosis

^a Department of Cardiology, Policlinico S. Orsola, University of Bologna, Italy
^b Department of Cardiac Surgery, Policlinico S. Orsola, University of Bologna, Italy

Received 16 October 2006; received in revised form 20 December 2006; accepted 22 December 2006.

^_* Corresponding author. Address: Department of Cardiology, University of Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy. Tel.: +39 051 349858; fax: +39 051 344859. (Email: tulliopalmerini{at}hotmail.com).

Objective: Preprocedural levels of C-reactive protein predict mid-term mortality after percutaneous coronary intervention for the treatment of unprotected left main coronary artery stenosis. However, there are no data regarding the impact of C-reactive protein on mid-term mortality in patients with unprotected left main coronary artery stenosis treated with coronary artery bypass graft. Methods: The predictive value of preoperative C-reactive protein levels, leukocyte counts, and fibrinogen levels were evaluated in a series of 108 patients who underwent coronary artery bypass graft surgery at our Institution from 1st January 2002 to 31st April 2005. Patients were divided in two groups: Group 1 included patients with C-reactive protein levels in quartiles IV (C-reactive protein levels 1.22 mg/dl) and Group 2 included patients with C-reactive protein levels in quartiles I + II + III. Results: At 9-month follow-up the rate of mortality was 25.9% in Group 1 and 4.9% in Group 2 (hazard ratio = 5.86, 95% confidence intervals = 1.71–20.03; p = 0.005). In all patients who had cardiac mortality, C-reactive protein levels were >0.5 mg/dl. In the multivariate analysis age >75 years, peripheral vascular disease and C-reactive protein quartiles were the only independent predictors of mortality. Conclusions: Elevated preoperative levels of C-reactive protein indicate an increased risk of death after coronary artery bypass graft surgery for the treatment of unprotected left main coronary artery stenosis. Inflammatory risk assessment in patients with unprotected left main coronary artery stenosis provides incremental prognostic value for adequate preoperative patient stratification.

Key Words: Coronary artery bypass • Left main • Inflammation

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