EVALUATION OF LABORATORY AND IMAGING PARAMETERS IN PATIENTS UNDERGOING OPEN HEART SURGERY

Abstract

Objective: Coronary artery bypass grafting (CABG) remains a widely performed surgical intervention for coronary artery disease. Despite advances in perioperative care and preoperative risk stratification, postoperative complications and mortality continue to pose significant clinical challenges. This study aimed to investigate the prognostic value of platelet related parameters specifically, mean platelet volume (MPV) and platelet count (PLT) in predicting postoperative outcomes and 30-day mortality in patients undergoing CABG. Material and Methods: This retrospective, single-center study included 406 adult patients who presented to the emergency department with acute coronary syndrome and subsequently underwent isolated CABG between 2019 and 2023. Demographic characteristics, preoperative EuroSCORE II and logEuroSCORE values, laboratory parameters and echocardiographic findings were recorded. Postoperative outcomes included 30-day mortality, major adverse cardiac events (MACE) and composite poor outcomes. Hematologic and biochemical parameters were analyzed at admission and on postoperative day 30 or the day of death. Associations between these variables and clinical outcomes were assessed using ROC and regression analyses. Results: Among the 406 patients (mean age: 63.5±8.6 years; 76.1% male), the 30-day mortality rate was 4.7%, with MACE and poor outcomes occurring in 9.4% and 10.1% of cases, respectively. Postoperative MPV and PLT were significantly associated with all outcome groups (p <0.05). MPV demonstrated the highest predictive accuracy for mortality (AUC: 0.791 95% CI: 0.748-0.830), whereas PLT exhibited the strongest performance for predicting MACE (AUC: 0.691 95% CI: 0.644-0.736). Multivariate analysis confirmed that postoperative MPV was an independent predictor of mortality (OR: 2.738; 95% CI: 1.842-4.072; p <0.001). Conclusion: Routine postoperative monitoring of MPV and PLT may enhance early detection of high-risk patients following CABG, particularly among those initially classified as low-risk.These simple, ccessible markers could support clinical decision-making and improve outcomes in the early postoperative period.

Keywords

• Coronary artery bypass grafting
• mean platelet volume
• platelet count
• prognosis

Açık Kalp Cerrahisi Geçiren Hastalarda Laboratuvar ve Görüntüleme Parametrelerinin Değerlendirilmesi

Abstract

Amaç: Koroner arter bypass greftleme (KABG), koroner arter hastalığının tedavisinde yaygın olarak uygulanan bir cerrahi girişimdir. Perioperatif bakım ve preoperatif risk sınıflamasındaki ilerlemelere rağmen, postoperatif komplikasyonlar ve mortalite önemli klinik sorunlar olmaya devam etmektedir. Bu çalışmada, trombosit ile ilişkili parametrelerden ortalama trombosit hacmi (MPV) ve trombosit sayısının (PLT), KABG uygulanan hastalarda postoperatif sonuçlar ve 30 günlük mortaliteyi öngörmedeki prognostik değerleri araştırıldı. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmaya 2019-2023 yılları arasında akut koroner sendrom ile acil servise başvuran ve izole KABG uygulanan 406 erişkin hasta dâhil edildi. Hastaların demografik özellikleri, preoperatif EuroSCORE II ve logEuroSCORE değerleri, laboratuvar parametreleri ve ekokardiyografik bulguları kaydedildi. Postoperatif sonuçlar; 30 günlük mortalite, majör kardiyak olaylar (MACE) ve kötü klinik sonuçlar olarak tanımlandı. Hematolojik ve biyokimyasal parametreler başvuru anında ve postoperatif 30. günde veya ölüm gününde analiz edildi. Bu değişkenler ile klinik sonuçlar arasındaki ilişkiler ROC ve regresyon analizleri ile değerlendirildi. Bulgular: Çalışmaya dâhil edilen 406 hastanın (ortalama yaş: 63.5±8.6 yıl; %76.1 erkek) 30 günlük mortalite oranı %4.7, MACE oranı %9.4 ve kötü sonuç oranı %10.1 olarak saptandı. Postoperatif MPV ve PLT tüm sonuçlarla anlamlı ilişkili bulundu (p <0.05). MPV, mortalite için en yüksek öngörü doğruluğunu gösterdi (AUC: 0.791; %95 GA: 0.748-0.830), PLT ise MACE’i öngörmede en güçlü parametreydi (AUC: 0.691; %95 GA: 0.644-0.736). Çok değişkenli analizde postoperatif MPV, mortalitenin bağımsız bir prediktörü olarak saptandı (OR: 2.738; %95 GA: 1.842-4.072; p <0.001). Sonuç: Postoperatif dönemde MPV ve PLT’nin rutin takibi, özellikle başlangıçta düşük riskli olarak sınıflandırılan hastalarda yüksek riskli grupların erken dönemde belirlenmesine katkı sağlayabilir. Bu basit ve erişilebilir biyobelirteçler, klinik karar sürecini destekleyerek postoperatif hasta sonuçlarını iyileştirebilir.

Keywords

• Koroner arter baypas greftleme
• ortalama trombosit hacmi
• trombosit sayısı
• prognoz

References

1. Lawton JS, Tamis-Holland JE, Writing Committee Members, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(2):e21–e129.
2. Chung PJ, Carter TI, Burack JH, Tam S, Alfonso A, Sugiyama G. Predicting the risk of death following coronary artery bypass graft made simple: A retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. J Cardiothorac Surg. 2015;10:62.
3. Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: A systematic review and meta-analysis. J Cardiothorac Surg. 2021;16(1):172.
4. Roques F, Nashef SA, Michel P, et al. Risk factors and outcome in European cardiac surgery: Analysis of the EuroSCORE multinational database of 19,030 patients. Eur J Cardiothorac Surg. 1999;15(6):816–823.
5. Aydınlı B, Demir A, Güçlü ÇY, et al. Hematological predictors and clinical outcomes in cardiac surgery. J Anesth. 2016;30(5):770–778.
6. Lako S, Dedej T, Nurka T, et al. Hematological changes in patients undergoing coronary artery bypass surgery: A prospective study. Med Arch. 2015;69(3):181–186.
7. Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R, Idiz M. Preoperative platelet to lymphocyte ratio is associated with early morbidity and mortality after coronary artery bypass grafting. Heart Surg Forum. 2015;18(6):E255–E262.
8. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482–2494.

9. Beceren NG, Armağan HH, Oğuzlar FÇ, Cesur E, Gürdal O, Tomruk Ö. Can mean platelet volume be a prognosis predictor in viral infections: An example of COVID-19. Heliyon. 2023;9(11):e21983.
10. Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost. 2010;8(1):148–156.
11. Mahla E, Suarez TA, Bliden KP, et al. Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: The TARGET-CABG study. Circ Cardiovasc Interv. 2012;5(2):261–269.
12. Mujtaba SS, Ledingham S, Shah AR, Schueler S, Clark S, Pillay T. Thrombocytopenia after aortic valve replacement: Comparison between sutureless Perceval S valve and Perimount Magna Ease bioprosthesis. Braz J Cardiovasc Surg. 2018;33(2):169–175.
13. Griffin BR, Jovanovich A, You Z, Palevsky P, Faubel S, Jalal D. Effects of baseline thrombocytopenia and platelet decrease following renal replacement therapy initiation in patients with severe acute kidney injury. Crit Care Med. 2019;47(4):e325–e331.
14. Ali RA, Wuescher LM, Worth RG. Platelets: Essential components of the immune system. Curr Trends Immunol. 2015;16:65–78.
15. Unal EU, Ozen A, Kocabeyoglu S, et al. Mean platelet volume may predict early clinical outcome after coronary artery bypass grafting. J Cardiothorac Surg. 2013;8:91.
16. Guven A, Caliskan M, Ciftci O, Barutcu I. Increased platelet activation and inflammatory response in patients with masked hypertension. Blood Coagul Fibrinolysis. 2013;24(2):170–176.
17. Bagger JP, Zindrou D, Taylor KM. Leukocyte count: A risk factor for coronary artery bypass graft mortality. Am J Med. 2003;115(8):660–663.
18. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995–1002.
19. Westenbrink BD, Kleijn L, de Boer RA, et al. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery: Insights from the IMAGINE trial. Heart. 2011;97(19):1590–1596.
20. Loor G, Li L, Sabik JF, et al. Nadir hematocrit during cardiopulmonary bypass: End-organ dysfunction and mortality. J Thorac Cardiovasc Surg. 2012;144(3):654–660.e4.
21. Skeith L, Baumann Kreuziger L, Crowther MA, Warkentin TE. A practical approach to evaluating postoperative thrombocytopenia. Blood Adv. 2020;4(4):776–783.
22. Xu K, Chan NC, Hirsh J, et al. Quantifying immature platelets as markers of increased platelet production after coronary artery bypass grafting surgery. Eur J Haematol. 2018;101(3):362–367.
23. Delgado-García G, Galarza-Delgado DÁ, et al. Mean platelet volume is decreased in adults with active lupus disease. Rev Bras Reumatol. 2016;56(6):504–508.
24. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009;63(10):1509–1515.
25. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47–58.
26. Bath PM, Butterworth RJ. Platelet size: Measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996;7(2):157–161.
27. Griffin BR, Bronsert M, Reece TB, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg. 2020;110(1):50–57.
28. Miceli A, Romeo F, Glauber M, de Siena PM, Caputo M, Angelini GD. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. J Cardiothorac Surg. 2014;9:137.
29. Alptekin GS. Early postoperative thrombocytopenia following cardiac surgery. Ankara Univ Tıp Fak Mecm. 2023;76(3):265–270.
30. Seyyed-Mohammadzad MH, Eskandari R, Rezaei Y, et al. Prognostic value of mean platelet volume in patients undergoing elective percutaneous coronary intervention. Anatol J Cardiol. 2015;15(1):25–30.
31. Yan S, Gao S, Lou S, Zhang Q, Wang Y, Ji B. Risk factors of thrombocytopenia after cardiac surgery with cardiopulmonary bypass. Braz J Cardiovasc Surg. 2023;38(3):389–397.