Role of intercellular aggregates and oxidative stress markers in assessment of cardiovascular outcomes in patients after coronary artery bypass grafting

Aim: To compare the levels of C-reactive protein (CRP), circulating cell aggregates (including P-selectin-expressing aggregates), lipid profiles, and platelet chemiluminescence activity in patients with and without adverse cardiovascular events following coronary artery bypass grafting (CABG).

Material and Methods. The study enrolled 102 patients with angina pectoris (functional class II–IV) who underwent CABG. Prior to CABG, comprehensive blood analysis and lipid profile assessment were performed. Both preand postoperatively, platelet chemiluminescence and flow cytometry analyses were conducted. Composite endpoints (worsening angina class, progression of heart failure, myocardial infarction, stroke, cardiovascular death, or repeat revascularization) were evaluated during hospitalization (8–10 days post-CABG) and at 23.3 ± 7.6 months postoperatively.

Results. Composite endpoints occurred in 16 patients. Significant differences were observed between groups (no events vs. adverse outcomes). Pre-CABG: monocyte-platelet aggregates: 13.4% [5.9; 24.2] vs. 34.9% [19.05; 50.25], p = 0.001; Mean fluorescence intensity (MFI) of P-selectin-expressing neutrophil-platelet aggregates: 4.85 AU [2.99; 8.79] vs. 12.5 AU [5.09; 15.3], p = 0.005; MFI of P-selectin-expressing monocyte-platelet aggregates: 4.27 AU [2.6; 7.76] vs. 9.53 AU [6.68; 14.8], p = 0.006. Post-CABG: P-selectin-expressing neutrophil-platelet aggregates: 75.7% [62.36; 90.54] vs. 92.3% [80; 99.29], p = 0.027. The median time to peak lucigenin-enhanced platelet chemiluminescence pre-CABG was significantly shorter in patients with adverse events compared to event-free patients (212 s [53; 621] vs. 885 s [257.75; 2087], p = 0.032). Similarly, the median time to peak spontaneous neutrophil chemiluminescence with lucigenin was reduced in the adverse events group (847 s [565; 1018] vs. 1355 s [1065.5; 1898.5], p = 0.017).

Conclusion. Patients with composite adverse cardiovascular events exhibited significantly different MFI and platelet-leukocyte aggregate counts (preand post-CABG), pre-operative platelet/neutrophil chemiluminescence peak times, and cardiopulmonary bypass durations compared to event-free patients. These parameters may serve as predictive biomarkers for post-CABG cardiovascular risk and warrant further investigation.

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