Oxidative Stress in Patients before and after On-Pump and Off-Pump Coronary Artery Bypass Grafting: Relationship with Syntax Score

Petar Vukicevic, Aleksandra Klisic, Vojislava Neskovic, Luka Babic, Aleksandar Mikic, Natasa Bogavac-Stanojevic, Milos Matkovic, Vladimir Milićević, Nemanja Aleksic, Jelena Kotur-Stevuljevic, Petar Vukicevic, Aleksandra Klisic, Vojislava Neskovic, Luka Babic, Aleksandar Mikic, Natasa Bogavac-Stanojevic, Milos Matkovic, Vladimir Milićević, Nemanja Aleksic, Jelena Kotur-Stevuljevic

Abstract

Objective: Coronary artery bypass grafting (CABG) represents the significant source of increased oxidative stress (OS). We aimed to follow the OS status parameters (i.e., ischemia-modified albumin (IMA), malondialdehyde (MDA), superoxide anion, prooxidant-antioxidant balance (PAB), total oxidant status (TOS), total antioxidant status (TAS), and superoxide-dismutase (SOD)) change through the predefined study times in two different surgical procedures, i.e., cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting (OPCAB). Additionally, we aimed to investigate those OS status parameters in specific study times according to SYNTAX score (SS), an established angiographic score for evaluating the extensity and severity of coronary artery disease. Patients and Methods. A total of 107 patients that were planned to undergo CABG were included (i.e., 47 patients in OPCAB and 60 patients in CPB group). Blood samples were taken at 6 time intervals: before surgery (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after termination of the operation (t6).

Results: IMA levels were higher in CPB than that in OPCAB baseline and rose in CPB group in t2 point. TOS decreased in both study groups, compared to baseline values, but without statistical significance. Superoxide anion and PAB significantly increased in t3-t6 study times, in both groups. MDA significantly increased only in CPB group in t5 and t6 interval. MDA was significantly higher in CPB group compared to OPCAB in t6 study point. CPB patients had significantly lower TAS compared to OPCAB patients at the beginning and in t2 and t3 study points. They also had significantly lower SOD activities compared to OPCAB, baseline, and in several study points. Moreover, TAS, SOD, and TAS/TOS ratio were significantly lower, whereas PAB and TOS/TAS were significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of high SS.

Conclusion: CPB patients were in more severe ischemia baseline than OPCAB group and IMA rose in CPB patients immediately after the surgery end, but not later. Also, the antioxidant status was significantly lower, whereas the prooxidant status was significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of CAD (as determined with SS), showing that SOD and IMA had very good discriminatory capability towards higher SS status.

Conflict of interest statement

All authors declare no conflicts of interest.

Copyright © 2021 Petar Vukicevic et al.

Figures

Figure 1
Figure 1
Dynamics of oxidative stress parameters' changes in CABG, precisely two surgery types, i.e., CPB and OPCAB before surgery and after the procedure in defined study points. (a) Total oxidative status (sTOS), (b) superoxide anion (pO2.–), (c) prooxidative-antioxidative balance (sPAB), (d) malondyaldehide (sMDA), (e) total antioxidative status (sTAS), and (f) superoxide-dismutase (pSOD). ∗, ∗∗, ∗∗∗P < 0.05; 0.01; 0.001 OPCAB vs. the same time point in CPB group. a, aa, aaaP < 0.05; 0.01; 0.001 in CPB group (t2-t5) vs. baseline. b, bb, bbbP < 0.05; 0.01; 0.001 in OPCAB group (t2-t5) vs. baseline. s: serum; p: plasma.
Figure 2
Figure 2
ROC analysis of different OSS parameters as SYNTAX Score value predictors. AUC (SE): area under the curve (standard error); 95th CI (confidence interval); P: significance. Logistic regression models of integrated parameters (t1-t6 study times) are presented.
Figure 3
Figure 3
Ischemia-modified albumin (sIMA) concentration in CABG subjects and according the two surgery types (CPB and OPCAB) before surgery (t1) and after the procedure (t2-t6). ∗, ∗∗, P < 0.05; 0.01 OPCAB vs. the same time point in CPB group; s: serum.

References

    1. Hatemi A. C., Çeviker K., Tongut A., Özgöl İ., Mert M., Kaya A. Oxidant status following cardiac surgery with phosphorylcholine-coated extracorporeal circulation systems. Oxidative Medicine and Cellular Longevity. 2016;2016:10. doi: 10.1155/2016/3932092.3932092
    1. Zakkar M., Guida G., Suleiman M. S., Angelini G. D. Cardiopulmonary bypass and oxidative stress. Oxidative Medicine and Cellular Longevity. 2015;2015:8. doi: 10.1155/2015/189863.189863
    1. Raja S. G., Berg G. A. Impact of off-pump coronary artery bypass surgery on systemic inflammation: current best available evidence. Journal of Cardiac Surgery. 2007;22(5):445–455. doi: 10.1111/j.1540-8191.2007.00447.x.
    1. Cleveland J. C., Jr., Shroyer A. L., Chen A. Y., Peterson E., Grover F. L. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. The Annals of Thoracic Surgery. 2001;72(4):1282–1289. doi: 10.1016/S0003-4975(01)03006-5.
    1. Menasché P. The systemic factor: the comparative roles of cardiopulmonary bypass and off- pump surgery in the genesis of patient injury during and following cardiac surgery. The Annals of Thoracic Surgery. 2001;72(6):S2260–S2265. doi: 10.1016/S0003-4975(01)03286-6.
    1. Marui A., Okabayashi H., Komiya T., et al. Benefits of off-pump coronary artery bypass grafting in high-risk patients. Circulation. 2012;126(11_supplement_1):S151–S157. doi: 10.1161/CIRCULATIONAHA.111.083873.
    1. Meharwal Z. S., Mishra Y. K., Kohli V., Bapna R., Singh S., Trehan N. Off-pump multivessel coronary artery surgery in high-risk patients. The Annals of Thoracic Surgery. 2002;74(4):1353–1357. doi: 10.1016/s0003-4975(02)03915-2.
    1. Kowalewski M., Jasiński M., Staromłyński J., et al. On-pump vs. off-pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK) PLoS ONE. 2020;15(4):p. e0231950. doi: 10.1371/journal.pone.0231950.
    1. Lamy A. R., Devereaux P. J., Yusuf S. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. The New England Journal of Medicine. 2017;376(9):894–895. doi: 10.1056/NEJMc1700247.
    1. Vukicevic P., Klisic A., Kotur-Stevuljevic J., et al. Paraoxonase 1 low activity and SYNTAX score may predict postoperative complications after coronary artery surgery. European Review for Medical and Pharmacological Sciences. 2021;25:1511–1521. doi: 10.26355/eurrev_202102_24858.
    1. Thielmann M., Pasa S., Holst T., et al. Heart-Type Fatty Acid Binding Protein and Ischemia-Modified Albumin for Detection of Myocardial Infarction After Coronary Artery Bypass Graft Surgery. The Annals of Thoracic Surgery. 2017;104(1):130–137. doi: 10.1016/j.athoracsur.2016.10.051.
    1. Vogt S., Sattler A., Sirat A. S., et al. Different Profile of Antioxidative Capacity Results in Pulmonary Dysfunction and Amplified Inflammatory Response After CABG Surgery. The Journal of Surgical Research. 2007;139(1):136–142. doi: 10.1016/j.jss.2006.09.011.
    1. Kanko M., Yavuz S., Duman C., Hosten T., Oner E., Berki T. Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery. Journal of Cardiothoracic Surgery. 2012;7(1) doi: 10.1186/1749-8090-7-3.
    1. Serruys P. W., Onuma Y., Garg S., et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009;5(1):50–56. doi: 10.4244/eijv5i1a9.
    1. Garg S., Sarno G., Garcia-Garcia H. M., et al. A new tool for the risk stratification of patients with complex coronary artery Disease. Circulation. Cardiovascular Interventions. 2010;3(4):317–326. doi: 10.1161/CIRCINTERVENTIONS.109.914051.
    1. Nashef S. A., Roques F., Sharples L. D., et al. EuroSCORE II. European Journal of Cardio-Thoracic Surgery. 2012;41(4):734–745. doi: 10.1093/ejcts/ezs043.
    1. Auclar C., Voisin E. Nitroblue tetrazolium reduction. In: Greenworld R. A., editor. CRC Handbook of Methods for Oxygen Radical Research. Boca Raton, Fla: CRC Press; 1985. pp. 123–132.
    1. Alamdari D. H., Paletas K., Pegiou T., Sarigianni M., Befani C., Koliakos G. A novel assay for the evaluation of the prooxidant-antioxidant balance, before and after antioxidant vitamin administration in type II diabetes patients. Clinical Biochemistry. 2007;40(3-4):248–254. doi: 10.1016/j.clinbiochem.2006.10.017.
    1. Girotti M. J., Khan N., Mc Lellan B. A. Early Measurement of Systemic Lipid Peroxidation Products in the Plasma of Major Blunt Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care. 1991;31(1):32–35. doi: 10.1097/00005373-199101000-00007.
    1. Misra H. P., Fridovich I. The Role of Superoxide Anion in the Autoxidation of Epinephrine and a Simple Assay for Superoxide Dismutase. The Journal of Biological Chemistry. 1972;247(10):3170–3175. doi: 10.1016/S0021-9258(19)45228-9.
    1. Bar–Or D., Lau E., Winkler J. V. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia--a preliminary report1. The Journal of Emergency Medicine. 2000;19(4):311–315. doi: 10.1016/S0736-4679(00)00255-9.
    1. Erel O. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. Clinical Biochemistry. 2004;37(4):277–285. doi: 10.1016/j.clinbiochem.2003.11.015.
    1. Erel O. A new automated colorimetric method for measuring total oxidant status. Clinical Biochemistry. 2005;38(12):1103–1111. doi: 10.1016/j.clinbiochem.2005.08.008.
    1. Klisic A., Kavaric N., Vujcic S., Spasojevic-Kalimanovska V., Kotur-Stevuljevic J., Ninic A. Total oxidant status and oxidative stress index as indicators of increased Reynolds Risk Score in postmenopausal women. European Review for Medical and Pharmacological Sciences. 2020;24(19):10126–10133. doi: 10.26355/eurrev_202010_23232.
    1. Šimundić A. M. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009;19(4):203–211.
    1. Luyten C. R., van Overveld F. J., De Backer L. A., et al. Antioxidant defence during cardiopulmonary bypass surgery. European Journal of Cardio-Thoracic Surgery. 2005;27(4):611–616. doi: 10.1016/j.ejcts.2004.12.013.
    1. Granger D. N., Kvietys P. R. Reperfusion injury and reactive oxygen species: the evolution of a concept. Redox Biology. 2015;6:524–551. doi: 10.1016/j.redox.2015.08.020.
    1. Klisic A., Kocic G., Kavaric N., Jovanovic M., Stanisic V., Ninic A. Body mass index is independently associated with xanthine oxidase activity in overweight/obese population. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2020;25(1):9–15. doi: 10.1007/s40519-018-0490-5.
    1. Klisic A., Kavaric N., Vujcic S., Spasojevic-Kalimanovska V., Kotur-Stevuljevic J., Ninic A. Factorial analysis of the cardiometabolic risk influence on redox status components in adult population. Oxidative Medicine and Cellular Longevity. 2021;2021:9. doi: 10.1155/2021/6661940.6661940
    1. Klisic A., Kavaric N., Stanisic V., et al. Endocan and a novel score for dyslipidemia, oxidative stress and inflammation (DOI score) are independently correlated with glycated hemoglobin (HbA1c) in patients with prediabetes and type 2 diabetes. Archives of Medical Science. 2020;16(1):42–50. doi: 10.5114/aoms.2019.87541.

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