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

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

doi:10.1155/2021/8915253

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

Oxid Med Cell Longev. 2021 Jun 26:2021:8915253. doi: 10.1155/2021/8915253. eCollection 2021.

Authors

Petar Vukicevic^{1

2}, Aleksandra Klisic³, Vojislava Neskovic^{2

4}, Luka Babic¹, Aleksandar Mikic^{5

6}, Natasa Bogavac-Stanojevic⁷, Milos Matkovic^{6

8}, Svetozar Putnik^{6

8}, Nemanja Aleksic^{6

8}, Jelena Kotur-Stevuljevic⁷

Affiliations

¹ Clinic for Cardiac Surgery, Military Medical Academy, Belgrade, Serbia.
² University of Defense, Medical Faculty of the Military Medical Academy, Belgrade, Serbia.
³ Primary Health Care Center, University of Montenegro-Faculty of Medicine, Podgorica, Montenegro.
⁴ Clinic for Anesthesiology and Critical Care, Military Medical Academy, Belgrade, Serbia.
⁵ Clinic for Cardiac Surgery, UC Clinical Centre, Belgrade, Serbia.
⁶ University of Belgrade-Faculty of Medicine, Belgrade, Serbia.
⁷ Department for Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Belgrade, Serbia.
⁸ Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.

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 96^th 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), 95^th 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.

MeSH terms

Coronary Artery Bypass / methods*
Female
Humans
Male
Middle Aged
Oxidative Stress / immunology*
Platelet Activation / immunology*