Chen Lianxin, Tiemuerniyazi Xieraili, Yang Ziang, He Liaoming, Nan Yifeng, Song Yangwu, Zhao Wei, Feng Wei
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China.
J Cardiothorac Surg. 2024 Dec 31;19(1):697. doi: 10.1186/s13019-024-03272-y.
Little is known about the role of D-dimer (DD) on the prognosis of patients undergoing coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG).
A total of 371 patients undergoing CE with CABG between January 2018 and July 2022 were retrospectively enrolled. The primary endpoint was the perioperative major adverse cardiovascular and cerebrovascular events (MACCE). Univariate logistic regression was performed to detect the relationship between preoperative DD level and the occurrence of perioperative MACCE. Receiver operating characteristics method was applied to determine the optimal cut-off threshold, while the multivariable logistic regression analysis was used to adjust the potential confounders.
Univariate logistic regression revealed that preoperative DD level was associated with increased risk of perioperative MACCE. The optimal cut-off for DD was 0.235 µg/ml. More patients in the high DD group suffered from perioperative MACCE than the low DD group (13.2% vs. 3.9%, P = 0.004), even after multiple adjustment (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 1.07-8.04, P = 0.036) in the multivariable logistic analysis. The occurrence of perioperative myocardial infarction was also much higher in high DD group (3.1% vs. 11.2%, P = 0.013).
In conclusion, high preoperative DD levels might predict an increased risk of perioperative adverse events after CE with CABG.
关于D-二聚体（DD）在接受冠状动脉内膜切除术（CE）联合冠状动脉旁路移植术（CABG）患者预后中的作用，目前所知甚少。
回顾性纳入2018年1月至2022年7月期间371例接受CE联合CABG的患者。主要终点是围手术期主要不良心血管和脑血管事件（MACCE）。进行单因素逻辑回归以检测术前DD水平与围手术期MACCE发生之间的关系。应用受试者工作特征方法确定最佳截断阈值，同时使用多因素逻辑回归分析来调整潜在混杂因素。
单因素逻辑回归显示，术前DD水平与围手术期MACCE风险增加相关。DD的最佳截断值为0.235μg/ml。高DD组围手术期发生MACCE的患者多于低DD组（13.2%对3.9%，P = 0.004），即使在多因素逻辑分析中进行多次调整后（比值比[OR]：2.93，95%置信区间[CI]：1.07 - 8.04，P = 0.036）也是如此。高DD组围手术期心肌梗死的发生率也高得多（3.1%对11.2%，P = 0.013）。
总之，术前高DD水平可能预示CE联合CABG术后围手术期不良事件风险增加。
