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OBJECTIVE: Objective:
Myocardial injury occurs in patients that undergo coronary artery bypass grafting (CABG). The remodeling process is usually self-limiting. Some would ultimately enjoy preserved cardiac function and prolonged survival while others develop secondary ventricular remodeling where the myocardial strain exceeds the pathological threshold and releases a soluble biomarker ST2 (sST2), a member of the interleukin receptor family. Previous studies have shown that ST2 level after admission for heart failure and myocardial infarction is a potent predictor of adverse outcome. Here, we serially tested and compared sST2 levels among patients undergoing CABG by sternotomy (sCABG) vs. minimally invasive robotic technique (rCABG). We hypothesize that the intraoperative myocardial strain is a patho-physiologically important predictor of mortality within the first post-operative year.
METHODS: Methods:
Blood was collected from 410 patients at: 1) Preop (preoperatively prior to skin incision), 2) Postop (30 minutes after surgery), 3) 24 hour, and 4) 72 hour. Serum was stored at -80OC until analysis for the concentration of sST2 using an enzyme-linked immunosorbent assay with single freeze-thaw cycle.
RESULTS: Results:
Death occurred in 9 patients (2.2%) at 30 days and 32 patients (7.8%) at 1 year after CABG. 58 rCABG and 58 sCABG patients with matching clinical and biochemical risk factors have similar mean level of sST2 (ng/ml) at preop, postop and 72 hour but significantly different at 24 hour (2.95±0.46 vs. 4.32±0.61, P = 0.05), respectively. Mean sST2 level at 24 hours was significantly elevated in decedents vs. survivors (7.33 vs. 2.68, P <0.001). Length of stay was also shorter for rCABG patients in comparison to sCABG.
CONCLUSIONS: Conclusions:
After stratifying for clinical predictors and biomarkers, sST2 elevation after CABG was an independent predictor of 1year mortality. Assessment of this novel biomarker after CABG may improve mortalities associated with conventional cases and prolong survival after CABG.