Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID Lille France.
Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal Montreal Canada.
J Am Heart Assoc. 2024 Sep 3;13(17):e034255. doi: 10.1161/JAHA.123.034255. Epub 2024 Aug 29.
Cardiac surgery triggers sterile innate immune responses leading to postoperative complications. Clonal hematopoiesis (CH) is associated with short-term inflammation-mediated outcomes after cardiac surgery. The impact of CH on long-term postoperative outcomes remains unknown.
In this cohort study, patients undergoing elective cardiac surgery were included from January 2017 to September 2019. Patients were screened for CH using a predefined gene panel of 19 genes. Recorded clinical events were all-cause death, major adverse cardiac and cerebral events including cardiovascular death, myocardial infarction or nonscheduled coronary revascularization, stroke, and hospitalization for acute heart failure. The primary study outcome was time to a composite criterion including all-cause mortality and major adverse cardiac and cerebral events. Among 314 genotyped patients (median age: 67 years; interquartile range 59-74 years), 139 (44%) presented with CH, based on a variant allelic frequency ≥1%. Carriers of CH had a higher proportion of patients with a history of atrial fibrillation (26% for CH versus 17% for non-CH carriers, =0.022). The most frequently mutated genes were , , and . After a median follow-up of 1203 [813-1435] days, the primary outcome occurred in 50 patients. After multivariable adjustment, CH was independently associated with a higher risk for the primary outcome (hazard ratio, 1.88 [95% CI, 1.05-3.41], =0.035). Most adverse events occurred in patients carrying variants.
In patients undergoing cardiac surgery, CH is frequent and associated with a 2-fold increased long-term risk for major adverse clinical outcomes. CH is a novel risk factor for long-term postcardiac surgery complications and might be useful to personalize management decisions.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03376165.
心脏手术会引发无菌性固有免疫反应，导致术后并发症。克隆性造血（CH）与心脏手术后短期炎症介导的结果相关。CH 对长期术后结果的影响尚不清楚。
在这项队列研究中，纳入了 2017 年 1 月至 2019 年 9 月期间接受择期心脏手术的患者。使用预先确定的 19 个基因的基因面板筛查患者的 CH。记录的临床事件包括全因死亡、主要不良心脏和大脑事件，包括心血管死亡、心肌梗死或非计划性冠状动脉血运重建、卒中和因急性心力衰竭住院。主要研究结果是包括全因死亡率和主要不良心脏和大脑事件的复合标准的时间。在 314 名基因分型的患者（中位年龄：67 岁；四分位距 59-74 岁）中，根据变异等位基因频率≥1%，139 例（44%）存在 CH。携带 CH 的患者中，有房颤病史的患者比例更高（26%对 CH 携带者，17%对非-CH 携带者，=0.022）。最常突变的基因是 、 和 。中位随访 1203[813-1435]天后，有 50 例患者发生主要结局。经过多变量调整后，CH 与主要结局的风险增加独立相关（危险比，1.88[95%CI，1.05-3.41]，=0.035）。大多数不良事件发生在携带 变异的患者中。
在接受心脏手术的患者中，CH 很常见，与长期主要不良临床结局的风险增加 2 倍相关。CH 是心脏手术后长期并发症的一个新的危险因素，可能有助于做出个性化的治疗决策。
