Owens Christopher D, Ridker Paul M, Belkin Michael, Hamdan Allen D, Pomposelli Frank, Logerfo Frank, Creager Mark A, Conte Michael S
Division of Vascular Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Vasc Surg. 2007 Jan;45(1):2-9; discussion 9. doi: 10.1016/j.jvs.2006.08.048. Epub 2006 Nov 21.
Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) are associated with an increased risk of cardiovascular events and with the severity of peripheral arterial disease. The effects of inflammation on the development of vein graft disease remain speculative. We hypothesized that high levels of inflammatory markers would identify patients at increased risk for adverse events (graft failure, major cardiovascular events) after lower extremity bypass surgery.
Patients (n = 91) scheduled to undergo lower extremity bypass using autogenous vein were enrolled into a prospective study at two institutions. Exclusion criteria included the presence of major infection. A baseline plasma sample was obtained on the morning of lower extremity bypass. Biomarkers for inflammation included hsCRP, fibrinogen, and serum amyloid A (SAA). Values between patients with and without critical limb ischemia were compared. Proportions of events among dichotomized populations (upper limit of normal of each laboratory assay) were compared by log-rank test.
Of the patients undergoing lower extremity bypass, 69% were men, 53% were diabetic, 81% were smokers, and their mean ankle-brachial index was 0.51 +/- 0.19. The indication for lower extremity bypass was critical limb ischemia in 55%. There were no perioperative deaths and two early graft occlusions. During a mean follow-up of 342 days (range, 36-694 days) there were four deaths, 27 graft-related events, and 10 other cardiovascular events. No relationships were found between events and demographics, comorbidities, baseline ankle-brachial index, or statin use. High-sensitivity CRP (P = .005), fibrinogen (P < .001), and SAA (P = .0001) levels were associated with critical limb ischemia at presentation. Among patients with an elevated hsCRP (>5 mg/L) immediately before surgery, major postoperative vascular events occurred in 60% (21/35), compared with a 32% (18/56) rate in those with a baseline CRP <5 mg/L (P = .004, log-rank test). On multivariable analysis, only elevated hsCRP correlated with adverse graft-related or cardiovascular events (P = .018).
The inflammatory biomarkers of hsCRP, fibrinogen, and SAA correlate with peripheral arterial disease severity at presentation in patients undergoing lower extremity bypass. Patients with elevated hsCRP are at increased risk for postoperative vascular events, most of which are related to the vein graft. These findings suggest a potential relationship between inflammation and outcomes after lower extremity vein bypass surgery.
炎症标志物如高敏C反应蛋白（hsCRP）与心血管事件风险增加以及外周动脉疾病的严重程度相关。炎症对静脉移植血管疾病发展的影响仍存在推测。我们假设高水平的炎症标志物可识别下肢搭桥手术后发生不良事件（移植血管失败、重大心血管事件）风险增加的患者。
计划使用自体静脉进行下肢搭桥手术的患者（n = 91）在两家机构纳入一项前瞻性研究。排除标准包括存在严重感染。在下肢搭桥手术当天早晨采集基线血浆样本。炎症生物标志物包括hsCRP、纤维蛋白原和血清淀粉样蛋白A（SAA）。比较有和没有严重肢体缺血患者之间的数值。通过对数秩检验比较二分群体（每个实验室检测的正常上限）中的事件比例。
接受下肢搭桥手术的患者中，69%为男性，53%患有糖尿病，81%为吸烟者，其平均踝肱指数为0.51±0.19。下肢搭桥手术的指征为严重肢体缺血的患者占55%。围手术期无死亡病例，有2例早期移植血管闭塞。在平均342天（范围36 - 694天）的随访期间，有4例死亡，27例与移植血管相关的事件，以及10例其他心血管事件。未发现事件与人口统计学、合并症、基线踝肱指数或他汀类药物使用之间存在关联。高敏CRP（P = .005）、纤维蛋白原（P < .001）和SAA（P = .0001）水平与就诊时的严重肢体缺血相关。在手术前hsCRP升高（>5 mg/L）的患者中，术后主要血管事件发生率为60%（21/35），而基线CRP<5 mg/L的患者发生率为32%（18/56）（P = .004，对数秩检验）。多变量分析显示，只有hsCRP升高与不良移植血管相关或心血管事件相关（P = .018）。
hsCRP、纤维蛋白原和SAA等炎症生物标志物与接受下肢搭桥手术患者就诊时外周动脉疾病的严重程度相关。hsCRP升高的患者术后血管事件风险增加，其中大多数与移植静脉相关。这些发现提示炎症与下肢静脉搭桥手术后的结局之间可能存在关联。
