Gołąb Aleksandra, Plicner Dariusz, Rzucidło-Hymczak Anna, Tomkiewicz-Pająk Lidia, Gawęda Bogusław, Kapelak Bogusław, Undas Anetta
Faculty of Medicine and Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland.
Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland.
J Clin Med. 2022 Jan 4;11(1):246. doi: 10.3390/jcm11010246.
We previously demonstrated that enhanced oxidative stress and reduced nitric oxide bioavailability are associated with unfavorable outcomes early after coronary artery bypass grafting. It is not known whether these processes may impact long-term results. We sought to assess whether during long-term follow-up, markers of oxidative stress and nitric oxide bioavailability may predict cardiovascular mortality following bypass surgery.
We studied 152 consecutive patients (118 men, age 65.2 ± 8.3 years) who underwent elective, primary, isolated on-pump bypass surgery. We measured plasma 8-iso-prostaglandin F2α and asymmetric dimethylarginine before surgery and twice after surgery (18-36 h and 5-7 days). We assessed all-cause and cardiovascular death in relation to these two biomarkers during a mean follow-up time of 11.7 years.
The overall mortality was 44.7% (4.7 per 100 patient-years) and cardiovascular mortality was 21.0% (2.2 per 100 patient-years). Baseline 8-iso-prostaglandin F2α was associated with cardiovascular mortality (HR 1 pg/mL 1.010, 95% CI 1.001-1.021, = 0.036) with the optimal cut-off ≤ 364 pg/mL for higher survival rate (HR 0.460, 95% CI 0.224-0.942, = 0.030). Asymmetric dimethylarginine > 1.01 μmol/L measured 18-36 h after surgery also predicted cardiovascular death (HR 2.467, 95% CI 1.140-5.340, = 0.020). Additionally, elevated 8-iso-prostaglandin F2α measured at the same time point associated with all-cause mortality (HR 1 pg/mL 1.007, 95% CI 1.000-1.014, = 0.048).
Our findings indicate that in advanced coronary disease, increased oxidative stress, reflected by 8-iso-prostaglandin F2α before bypass surgery and enhanced asymmetric dimethylarginine accumulation just after the surgery are associated with cardiovascular death during long-term follow-up.
我们之前证明，氧化应激增强和一氧化氮生物利用度降低与冠状动脉旁路移植术后早期不良结局相关。尚不清楚这些过程是否会影响长期结果。我们试图评估在长期随访期间，氧化应激和一氧化氮生物利用度标志物是否可预测旁路手术后的心血管死亡率。
我们研究了152例连续接受择期、初次、单纯体外循环旁路手术的患者（118名男性，年龄65.2±8.3岁）。我们在手术前以及手术后两次（18 - 36小时和5 - 7天）测量血浆8 - 异前列腺素F2α和不对称二甲基精氨酸。在平均11.7年的随访期内，我们评估了与这两种生物标志物相关的全因死亡和心血管死亡情况。
总死亡率为44.7%（每100患者年4.7例），心血管死亡率为21.0%（每100患者年2.2例）。基线8 - 异前列腺素F2α与心血管死亡率相关（每1 pg/mL的HR为1.010，95%CI为1.001 - 1.021，P = 0.036），对于较高生存率，最佳截断值≤364 pg/mL（HR为0.460，95%CI为0.224 - 0.942，P = 0.030）。术后18 - 36小时测量的不对称二甲基精氨酸>1.01 μmol/L也可预测心血管死亡（HR为2.467，95%CI为1.140 - 5.340，P = 0.020）。此外，在同一时间点测量的升高的8 - 异前列腺素F2α与全因死亡率相关（每1 pg/mL的HR为1.007，95%CI为1.000 - 1.014，P = 0.048）。
我们的研究结果表明，在晚期冠状动脉疾病中，旁路手术前8 - 异前列腺素F2α反映的氧化应激增加以及手术后不对称二甲基精氨酸积累增强与长期随访期间的心血管死亡相关。
