Beyond Anatomy: The Combined Power of SYNTAX Score and Inflammatory Biomarkers in CABG Outcomes

Objectives: To investigate the relationship between the SYNTAX score and inflammatory markers (CRP, RDW, PDW) in patients undergoing coronary artery bypass grafting (CABG) and to evaluate their independent predictive roles in in-hospital mortality.
Methods: This retrospective, single-center study included 160 consecutive patients who underwent elective isolated CABG between January 2024 and April 2025. Preoperative SYNTAX scores were calculated, and inflammatory markers (CRP, RDW, PDW) were measured within 24 hours before surgery. The primary endpoint was in-hospital mortality. Correlation analyses, subgroup comparisons, and multivariate logistic regression were performed.
Results: CRP, RDW, and PDW levels significantly increased across higher SYNTAX categories. Positive correlations were observed between SYNTAX and CRP (ρ=0.27, p=0.003), RDW (ρ=0.24, p=0.006), and PDW (ρ=0.22, p=0.010). Multivariate logistic regression analysis demonstrated that SYNTAX (OR=1.12, p=0.014), CRP (OR=1.06, p=0.021), RDW (OR=1.09, p=0.029), and PDW (OR=1.18, p=0.028) were independent predictors of in-hospital mortality. The combined model yielded the highest discriminative performance (AUC=0.88) compared with the SYNTAX score alone (AUC=0.71).
Conclusion: The combined evaluation of the SYNTAX score with inflammatory markers (CRP, RDW, PDW) provides complementary prognostic value and significantly improves the prediction of in-hospital mortality in CABG patients. This integrated approach may enhance preoperative risk stratification and aid in the early identification of high-risk individuals.

Keywords: C-reactive protein (CRP), coronary artery bypass grafting (CABG), in-hospital mortality, red cell distribution width (RDW), SYNTAX score