Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland.
Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
Eur J Clin Invest. 2022 Jul;52(7):e13775. doi: 10.1111/eci.13775. Epub 2022 Mar 27.
Mortality after coronary artery bypass grafting (CABG) is primarily thromboembolic by nature. We investigated whether impaired fibrinolysis observed in cardiovascular diseases is associated with long-term mortality following CABG.
The study population comprised 292 consecutive patients (aged 64.6 ± 8.1 years) who underwent scheduled CABG. We measured plasma clot lysis time (CLT) preoperatively as a measure of fibrinolysis capacity. Cardiovascular and all-cause deaths were recorded during a median follow-up of 13.8 years.
CLT positively correlated with age (r = .56, p < .001), fibrinogen (r = .25, p = .002) and EuroSCORE I (r = .32, p < .001). The cardiovascular and overall mortality rates were 3.0 and 4.9 per 100 patient-years (32.4% vs 52.8%) respectively. In patients who died from cardiovascular and all causes, CLT was prolonged compared with survivors (both p < .050). Multivariable Cox regression analysis adjusted for potential confounders showed that long-term cardiovascular and all-cause deaths were associated with CLT (HR per 10 min 1.206; 95% CI 1.037-1.402, p = .015 and HR 1.164; 96% CI 1.032-1.309, p = .012), low-density lipoprotein cholesterol (HR per 1 mmol/L 1.556; 95% CI 1.205-2.010, p < .001 and HR 1.388; 96% CI 1.125-1.703, p = .002), C-reactive protein (HR per 10 mg/L 1.171; 95% CI 1.046-1.312, p = .006 and HR 1.127; 95% CI 1.005-1.237, p = .022) and EuroSCORE I (HR 1.173; 95% CI 1.016-1.355, p = .030 and HR 1.183; 95% CI 1.059-1.317, p = .003 respectively). Type 2 diabetes was solely associated with overall mortality (HR 1.594; 96% CI 1.088-2.334, p = .017).
In this study, we showed that reduced fibrin clot susceptibility to fibrinolysis is weekly associated with long-term mortality in advanced CAD.
冠状动脉旁路移植术（CABG）后的死亡率主要是血栓栓塞性的。我们研究了心血管疾病中观察到的纤溶功能障碍是否与 CABG 后的长期死亡率有关。
本研究纳入了 292 例连续接受择期 CABG 的患者（年龄 64.6±8.1 岁）。我们在术前测量了血浆血栓溶解时间（CLT），作为纤溶能力的衡量指标。在中位随访 13.8 年期间，记录了心血管和全因死亡。
CLT 与年龄（r=0.56，p<0.001）、纤维蛋白原（r=0.25，p=0.002）和 EuroSCORE I（r=0.32，p<0.001）呈正相关。心血管和全因死亡率分别为每 100 例患者 3.0 和 4.9 例（32.4% vs 52.8%）。在死于心血管和全因的患者中，CLT 较幸存者延长（均 p<0.050）。多变量 Cox 回归分析调整了潜在混杂因素后显示，长期心血管和全因死亡与 CLT 相关（每增加 10 分钟的 HR 为 1.206；95%CI 为 1.037-1.402，p=0.015 和 HR 为 1.164；96%CI 为 1.032-1.309，p=0.012），低密度脂蛋白胆固醇（每增加 1mmol/L 的 HR 为 1.556；95%CI 为 1.205-2.010，p<0.001 和 HR 为 1.388；96%CI 为 1.125-1.703，p=0.002）、C 反应蛋白（每增加 10mg/L 的 HR 为 1.171；95%CI 为 1.046-1.312，p=0.006 和 HR 为 1.127；95%CI 为 1.005-1.237，p=0.022）和 EuroSCORE I（HR 为 1.173；95%CI 为 1.016-1.355，p=0.030 和 HR 为 1.183；95%CI 为 1.059-1.317，p=0.003）。2 型糖尿病仅与全因死亡率相关（HR 为 1.594；95%CI 为 1.088-2.334，p=0.017）。
在这项研究中，我们表明，纤维蛋白血栓对纤溶的敏感性降低与晚期 CAD 的长期死亡率相关。
