高敏C反应蛋白可预测冠状动脉搭桥术后的预后。
High-sensitive C-reactive protein predicts outcome after coronary artery bypass.
作者信息
Wang Jianyang, Zheng Zhe, Yang Limeng, Zhang Lu, Fan Hongguang, Hu Shengshou
机构信息
State Key Laboratory of Cardiovascular Disease, Department of Cardiovacular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
出版信息
Asian Cardiovasc Thorac Ann. 2012 Oct;20(5):525-33. doi: 10.1177/0218492312439402.
BACKGROUND
Elevated high-sensitive C-reactive protein is a powerful independent predictor of cardiovascular events. However, there are scant data on its impact on midterm or long-term outcomes of coronary artery bypass grafting.
METHOD
We analyzed data of 2863 patients who underwent coronary artery bypass in 2006-2007. Early endpoints were hospital mortality and major morbidity. Midterm endpoints were overall mortality, major adverse cardiovascular events, and heart failure.
RESULTS
During hospital stay, 26 patients died and 288 suffered major morbidity. After 3.6 years of follow-up, 56 patients had died, 105 had major adverse cardiovascular events, and 70 developed heart failure. Multivariate analysis revealed every 1 mg·L(-1) increase of high-sensitive C-reactive protein was associated with increased odds ratio for early mortality (odds ratio = 2.50, p = 0.002), major morbidity (odds ratio = 1.38, p = 0.02), and hazard ratio for midterm mortality (hazard ratio = 1.68, p = 0.03), major adverse cardiovascular events (hazard ratio = 1.48, p = 0.04), and heart failure (hazard ratio = 1.88, p = 0.01). Preoperative high-sensitive C-reactive protein>2.5 mg·L(-1) predicted higher risks of early (hazard ratio = 2.69, p = 0.02) and midterm mortality (hazard ratio = 1.92, p = 0.02), major morbidity (hazard ratio = 1.46, p = 0.004), major adverse cardiovascular events (hazard ratio = 2.06, p<0.001), and heart failure (hazard ratio = 1.71, p = 0.03).
CONCLUSIONS
Elevated high-sensitive C-reactive protein (>2.5 mg·L(-1)) predicts poor early and midterm outcomes after coronary artery bypass.
背景
高敏C反应蛋白升高是心血管事件的有力独立预测指标。然而，关于其对冠状动脉旁路移植术中期或长期预后影响的数据却很少。
方法
我们分析了2006年至2007年接受冠状动脉旁路移植术的2863例患者的数据。早期终点为住院死亡率和主要并发症。中期终点为总死亡率、主要不良心血管事件和心力衰竭。
结果
住院期间，26例患者死亡，288例发生主要并发症。经过3.6年的随访，56例患者死亡，105例发生主要不良心血管事件，70例发生心力衰竭。多因素分析显示，高敏C反应蛋白每升高1 mg·L⁻¹与早期死亡率（比值比=2.50，p = 0.002）、主要并发症（比值比=1.38，p = 0.02）增加以及中期死亡率（风险比=1.68，p = 0.03）、主要不良心血管事件（风险比=1.48，p = 0.04）和心力衰竭（风险比=1.88，p = 0.01）的风险比增加相关。术前高敏C反应蛋白>2.5 mg·L⁻¹预示着早期（风险比=2.69，p = 0.02）和中期死亡率（风险比=1.92，p = 0.02）、主要并发症（风险比=1.46，p = 0.004）、主要不良心血管事件（风险比=2.06，p<0.001）和心力衰竭（风险比=1.71，p = 0.03）的风险更高。
结论
高敏C反应蛋白升高（>2.5 mg·L⁻¹）预示冠状动脉旁路移植术后早期和中期预后不良。
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