Hedman Anders, Larsson P Thomas, Alam Mahbubul, Wallen N Håkan, Nordlander Rolf, Samad Bassem Abdel
Department of Cardiology, Karolinska Institute at South Hospital (Södersjukhuset), Stockholm, Sweden.
Int J Cardiol. 2007 Aug 9;120(1):108-14. doi: 10.1016/j.ijcard.2006.09.004. Epub 2006 Dec 1.
Inflammation is a major contributor to atherosclerotic vascular disease. Inflammatory parameters such as C-reactive protein (CRP) and Interleukin-6 (IL-6) have been shown to be strong predictors of cardiovascular events. The association between preoperative inflammatory parameters and early graft occlusion as well as cardiovascular events after coronary artery bypass grafting (CABG) has not, however, been fully elucidated. The aims of the present study were to prospectively investigate the prognostic value of the inflammatory parameters IL-6, CRP, and endothelin (ET-1) to predict early graft occlusion as well as late cardiovascular events after CABG.
In the present study 99 patients undergoing CABG because of stable angina pectoris due to significant coronary artery disease were prospectively included. Coronary angiography was repeated 3 months after CABG in 81 patients in order to evaluate early graft occlusion. Blood samples were collected before CABG in all patients. Patients were followed up for a median of 5 (3-7) years after CABG.
Twenty-five patients (31%) had one or more occluded grafts at the 3-month control coronary angiography. The patients with occluded grafts had higher preoperative CRP and IL-6 levels in plasma [CRP 2.22 (1.11-4.47) mg/L vs. 1.23 (0.71-2.27) mg/L P=0.03] and [IL-6 2.88 (1.91-5.94) pg/mL vs. 2.15 (1.54-3.14) pg/mL P=0.006]. There were 23 late cardiovascular events among the 99 patients during the follow-up. Patients experiencing late cardiovascular events had higher preoperative IL-6 levels than those without late cardiovascular events [4.13 (1.83-5.87) pg/mL vs. 2.08 (1.53-2.29) pg/mL, P=0.002] whereas CRP levels did not differ significantly between the two groups [1.5 (0.79-4.41) mg/L vs. 1.33 (0.74-2.48) mg/L, P=0.41]. Looking at IL-6, a cut off value more than 3.8 pg/ml was associated with a significant higher risk for an early graft occlusion (P=0.04) and late cardiovascular events (P=0.00003). Preoperative endothelin-1 did not predict early graft occlusions or late cardiovascular events.
Raised preoperative IL-6 levels are predictors of both early graft occlusion and late cardiovascular events after CABG. Elevated preoperative CRP levels can predict early graft occlusion after CABG. Endothelin did not differ between the two groups.
炎症是动脉粥样硬化性血管疾病的主要促成因素。炎症参数如C反应蛋白（CRP）和白细胞介素-6（IL-6）已被证明是心血管事件的有力预测指标。然而，术前炎症参数与冠状动脉旁路移植术（CABG）后早期移植物闭塞以及心血管事件之间的关联尚未完全阐明。本研究的目的是前瞻性地研究炎症参数IL-6、CRP和内皮素（ET-1）对预测CABG后早期移植物闭塞以及晚期心血管事件的预后价值。
本研究前瞻性纳入了99例因严重冠状动脉疾病导致稳定型心绞痛而接受CABG的患者。81例患者在CABG术后3个月重复进行冠状动脉造影以评估早期移植物闭塞情况。所有患者在CABG术前采集血样。患者在CABG术后中位随访5（3 - 7）年。
在3个月的对照冠状动脉造影中，25例患者（31%）有一个或多个移植物闭塞。移植物闭塞的患者术前血浆CRP和IL-6水平较高[CRP 2.22（1.11 - 4.47）mg/L对1.23（0.71 - 2.27）mg/L，P = 0.03]以及[IL-6 2.88（1.91 - 5.94）pg/mL对2.15（1.54 - 3.14）pg/mL，P = 0.006]。在随访期间，99例患者中有23例发生晚期心血管事件。发生晚期心血管事件的患者术前IL-6水平高于未发生晚期心血管事件的患者[4.13（1.83 - 5.87）pg/mL对2.08（1.53 - 2.29）pg/mL，P = 0.002]，而两组之间CRP水平无显著差异[1.5（0.79 - 4.41）mg/L对1.33（0.74 - 2.48）mg/L，P = 0.41]。就IL-6而言，截断值大于3.8 pg/ml与早期移植物闭塞（P = 0.04）和晚期心血管事件（P = 0.00003）的显著更高风险相关。术前内皮素-1不能预测早期移植物闭塞或晚期心血管事件。
术前升高的IL-6水平是CABG后早期移植物闭塞和晚期心血管事件的预测指标。术前升高的CRP水平可预测CABG后早期移植物闭塞。两组之间内皮素无差异。
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