D-dimer is associated with arterial and venous coronary artery bypass graft occlusion

Alessandro Parolari, Laura Cavallotti, Daniele Andreini, Veronika Myasoedova, Cristina Banfi, Marina Camera, Paolo Poggio, Fabio Barili, GianLuca Pontone, Luciana Mussoni, Chiara Centenaro, Francesco Alamanni, Elena Tremoli, Coronary Bypass Grafting: Factors Related to Late Events and Graft Patency (CAGE) study investigators

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion.

METHODS: A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively.

RESULTS: There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P = .028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95% CI, 1.24-6.9; P = .078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95% CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95% CI, 1.15-6.2; P = .022 and OR, 2.5; 95% CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up.

CONCLUSIONS: We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.

Original languageEnglish
Pages (from-to)200-207.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number1
DOIs
Publication statusPublished - Jan 2018

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Coronary Artery Bypass
Transplants
Odds Ratio
Confidence Intervals
Biomarkers
fibrin fragment D
Mammary Arteries
Saphenous Vein
Observational Studies

Keywords

  • Journal Article

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D-dimer is associated with arterial and venous coronary artery bypass graft occlusion. / Parolari, Alessandro; Cavallotti, Laura; Andreini, Daniele; Myasoedova, Veronika; Banfi, Cristina; Camera, Marina; Poggio, Paolo; Barili, Fabio; Pontone, GianLuca; Mussoni, Luciana; Centenaro, Chiara; Alamanni, Francesco; Tremoli, Elena; Coronary Bypass Grafting: Factors Related to Late Events and Graft Patency (CAGE) study investigators.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 1, 01.2018, p. 200-207.e3.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion.METHODS: A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively.RESULTS: There were 46 of 503 (9.1{\%}) occluded grafts; of these, 29 (63{\%}) were venous and 17 (37{\%}) were arterial grafts; overall, 43 of 179 patients (24{\%}) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95{\%} confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95{\%} CI, 1.01-1.19; P = .028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95{\%} CI, 1.24-6.9; P = .078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95{\%} CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95{\%} CI, 1.15-6.2; P = .022 and OR, 2.5; 95{\%} CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up.CONCLUSIONS: We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.",
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note = "Copyright {\circledC} 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.",
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TY - JOUR

T1 - D-dimer is associated with arterial and venous coronary artery bypass graft occlusion

AU - Parolari, Alessandro

AU - Cavallotti, Laura

AU - Andreini, Daniele

AU - Myasoedova, Veronika

AU - Banfi, Cristina

AU - Camera, Marina

AU - Poggio, Paolo

AU - Barili, Fabio

AU - Pontone, GianLuca

AU - Mussoni, Luciana

AU - Centenaro, Chiara

AU - Alamanni, Francesco

AU - Tremoli, Elena

AU - Coronary Bypass Grafting: Factors Related to Late Events and Graft Patency (CAGE) study investigators

N1 - Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2018/1

Y1 - 2018/1

N2 - OBJECTIVE: In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion.METHODS: A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively.RESULTS: There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P = .028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95% CI, 1.24-6.9; P = .078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95% CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95% CI, 1.15-6.2; P = .022 and OR, 2.5; 95% CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up.CONCLUSIONS: We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.

AB - OBJECTIVE: In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion.METHODS: A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively.RESULTS: There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P = .028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95% CI, 1.24-6.9; P = .078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95% CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95% CI, 1.15-6.2; P = .022 and OR, 2.5; 95% CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up.CONCLUSIONS: We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.

KW - Journal Article

U2 - 10.1016/j.jtcvs.2017.04.043

DO - 10.1016/j.jtcvs.2017.04.043

M3 - Article

C2 - 28549694

VL - 155

SP - 200-207.e3

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

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