New Markers of Platelet Activation and Reactivity and Oxidative Stress Parameters in Patients Undergoing Coronary Artery Bypass Grafting.

Petar Vukicevic,Nemanja Aleksic,Jelena Kotur-Stevuljevic,Natasa Bogavac-Stanojevic,Milos Matkovic,Svetozar Putnik,Aleksandar Mikic,Luka Babic,Aleksandra Klisic,Vojislava Neskovic,Jinwei Tian

doi:10.1155/2021/8915253

Abstract

Objective Recent studies have shown that the red cell distribution width- (RDW-) to-platelet (PLT) count ratio (i.e., RPR) and the mean platelet volume (MPV)/PLT ratio (i.e. MPR) are more sensitive markers of atherosclerosis-connected risk than RDW and PLT alone. The present study is aimed at investigating the oxidative stress status and these two new markers of platelet activation in two different heart surgery modalities: cardiopulmonary bypass (CPB) and off-pump coronary artery bypass (OPCAB). We also aimed to test the possible relationship between RPR and MPR, respectively, and the severity and complexity of atherosclerotic plaque, measured as Syntax Score. Patients and Methods. A total of 107 patients encompassed this prospective study (i.e., 60 patients in CPB group and 47 patients in OPCAB). Blood samples were drawn at several time intervals: before skin incision (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after cessation of the operation (t6). Results The values of RPR and MPR were similar in CPB and OPCAB before surgery and started to rise in t2 (i.e., immediately after the intervention). This increase lasted to t5 (i.e., 48 hours after the intervention), when it became the highest. After that, both markers started to regress about the 96th hour after the beginning of surgery. Nominal values of both indices were higher in CPB than in OPCAB in all study points after the surgery. Furthermore, a significantly higher level of antioxidative parameters (i.e., total sulfhydryl groups and paraoxonase 1) in the OPCAB group compared to the CPB group was noted at t5 study point (i.e., 48 hours after the surgery), whereas no significant difference was noted in prooxidant levels (i.e., lipid hydroperoxides and advanced oxidation protein products) between these groups at this study point. MPR and RPR correlated positively with Syntax Score at several study points after the surgery completion. Syntax Score, MPR, and RPR showed good clinical accuracy in surgery-related complication prediction ((AUC = 0.736), 95th CI (0.616-0.856), P = 0.003)). Conclusion When combined, MPV, RDW, and platelet count, such as MPR and RPR, could be good predictors of coronary artery disease status, regarding the aspect of joint inflammation, oxidative stress, and thrombosis.

Highlights

Inflammation, and thrombosis are mutually involved in the atherosclerosis development, and progression of this features is evident as disease becomes irreversible [1, 2]
In order to get a more precise insight into the surgical condition influence on selected hematological parameters, the patients were categorized according to the surgical modality (CBP vs. OPCAB), and in each of the two main groups, further division was performed according to the number of bypass grafts patients received during the surgical revascularisation procedure
We constructed logistic regression models in order to get more accurate complication prediction, and the results of receiver operating characteristic (ROC) analysis showed that the combination of Syntax Score, MPR, and RPR showed the best accuracy, compared to other parameter combination (Table 4)

Summary

Introduction

Inflammation, and thrombosis are mutually involved in the atherosclerosis development, and progression of this features is evident as disease becomes irreversible [1, 2]. Oxidative stress and chronic systemic low-level inflammation and neurohumoral activation could cause increase in heterogeneity of erythrocytes in circulation and influence platelet reactivity [3, 4]. Anisocytosis, measured as RDW is a well-recognized predictor of unwanted clinical outcomes in different diseases, including coronary artery disease [11]. Increased RDW is connected with several different aspects of red blood cells metabolic specificities. There are data about the influence of anemia, iron concentration and status, so as cholesterol membrane content on cells’ deformability, shorter lifespan, and faster turnover, so all of these increase RDW, as a measure of erythrocyte activation upon united oxidative stress and inflammation conditions [8]

Methods

Results

Conclusion