Behavior of Ultrasensitive C-Reactive Protein in Myocardial Revascularization with and without Cardiopulmonary Bypass

Abstract

ObjectiveTo analyze the inflammation resulting from myocardial revascularization techniques with and without cardiopulmonary bypass, based on ultrasensitive C-reactive protein (US-CRP) behavior.MethodsA prospective non-randomized clinical study with 136 patients was performed. Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery bypass - ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary artery bypass - OPCAB). All study participants had blood samples collected for analysis of glucose, triglycerides, creatinine, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and creatinephosphokinase (CPK) in the preoperative period. The samples of creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after surgery. We also analyzed the preoperative biological variables of each patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body mass index, previous myocardial infarction, myocardial fibrosis). All angiographically documented patients with >70% proximal multiarterial stenosis and ischemia, documented by stress test or classification of stable angina (class II or III), according to the Canadian Cardiovascular Society, were included. Reoperations, combined surgeries, recent acute myocardial infarction, recent inflammatory disease, deep venous thrombosis or recent pulmonary thromboembolism, acute kidney injury or chronic kidney injury were not included.ResultsCorrelation values between the US-CRP curve and the ONCAB group, the treatment effect and the analyzed biological variables did not present expressive results. Laboratory variables were evaluated and did not correlate with the applied treatment (P>0.05).ConclusionThe changes in the US-CRP at each moment evaluated from the postoperative period did not show any significance in relation to the surgical technique applied.

Comparison of three types of coronary artery bypass grafting: preliminary results of AMIRI-CABG trial

“…Воспалительный ответ в 1-е сутки после операции был больше в группе КШ c ИК (2-я группа), чем в группе КШ без ИК (1-я группа), что согласуется с результатами других исследователей [10]. Однако начиная со 2-го дня и в последующие дни послеоперационного периода уровень СРБ в группе без ИК (1-я группа) становится больше, чем в группе с ИК (2-я группа).…”

“…Многие крупные обзоры ссылаются на исследования, в которых временной интервал оценки воспалительного ответа был коротким и не включал период более 2-3 дней после операции. Во многих исследованиях значения маркеров воспаления были представлены в виде точечной оценки, не приведена интервальная оценка концентрации в каждой контрольной точке [9,10]. Таким образом, несмотря на то что ишемически-реперфузионное повреждение (ИРП) миокарда и воспалительный ответ при разных типах КШ исследуется давно, появление новых материалов и технологий ИК, более селективных диагностических наборов для определения уровня кардиального тропонина, требуют более точного изучения обозначенной проблемы [7,11].…”

Inflammatory Biomarkers in Cardiac Surgery and the Suggestion of an Editors’ Heart Team

“…Based on the ultrasensitive C-reactive protein (us-CRP) behavior, Abrantes et al. [1] analyzed the inflammation resulting from myocardial revascularization techniques with (on-pump coronary artery bypass grafting - ONCAB) and without (off-pump coronary artery bypass grafting - OPCAB) cardiopulmonary bypass. The authors concluded that there was an increase in us-CRP in the postoperative period compared to the preoperative period.…”

“…This increase occurred in all moments assessed postoperatively. There was no difference in the us-CRP behavior between the two myocardial revascularization techniques [1] .…”

“…In 1930, Tillet and Francis published the first report on the occasional discovery of CRP. In 1943, the first clues to the possible connection between CRP and atherothrombotic events were described by Lofstrom and later by Kroop [1] . Looking at the "eternal pursuit" of credible and economically viable markers, are not we "going back to the past"?…”