Kevin R An, Sigrid Sandner, Joyce Peper, Yanzai Zhou, Jurrien M Ten Berg, Lamia Harik, Yunpeng Zhu, Laura M Willemsen, Qiang Zhao, Björn Redfors, Subodh Verma, Mario F L Gaudino
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引用次数: 0
摘要
背景：基线全身性炎症与冠状动脉旁路移植术（CABG）后较差的长期预后相关，但这种关联的机制尚不清楚。本研究旨在探讨术前白细胞（WBC）计数与冠脉搭桥移植失败的关系。方法：我们汇集了来自两项随机临床试验的患者数据，并进行了系统的冠脉搭桥成像。主要分析术前WBC计数与移植失败之间的关系，作为一个连续变量，在CABG后成像时，使用混合效应多变量逻辑回归模型。结果：共纳入910例患者和2036例移植物[1120例隐静脉移植物，828例左胸内动脉，76例右胸内动脉，12例桡动脉]。中位成像时间为1.01[四分位间距（IQR）， 0.99；1.03]年，术前中位WBC计数为7.1 [IQR, 6.0;8.4] × 109/L。在患者和单个移植水平上，WBC计数与移植失败均无关联[调整优势比（aOR） 1.07(95%可信区间（CI） 0.98;1.17), p = 0.11]和调整优势比（aOR） 1.09 (95% CI, 0.91;1.30), p = 0.37]。当作为二分类变量[≥11 vs. 9/L]和按四分位数进行评估时，白细胞计数在患者和个体移植水平上与移植失败无关。结论：在对来自两项随机临床试验的个体患者数据的汇总分析中，白细胞计数与CABG后移植物衰竭无关。已报道的炎症与冠状动脉搭桥之间的关联可能是通过其他机制介导的，例如原生冠状动脉疾病进展。对日常实践的影响：白细胞计数与移植物衰竭之间缺乏明确的关联，这表明术前白细胞计数不应常规用作冠脉搭桥后移植物衰竭的预测指标。
Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials.
Background: Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graft failure.
Methods: We pooled individual patient data from two randomized clinical trials with systematic CABG graft imaging. The primary analysis was the association between pre-operative WBC count and graft failure, as a continuous variable, at the time of imaging after CABG, using mixed-effects multivariable logistic regression models.
Results: Overall, 910 patients and 2,036 grafts were included in the analysis [1,120 saphenous vein grafts, 828 left internal thoracic arteries, 76 right internal thoracic arteries, and 12 radial arteries]. The median time to imaging was 1.01 [interquartile range (IQR), 0.99;1.03] years and the median pre-operative WBC count was 7.1 [IQR, 6.0;8.4] x 109/L. There was no association between WBC count and graft failure at both the patient and the individual graft level [adjusted odds ratio (aOR) 1.07 (95% confidence interval (CI), 0.98;1.17), p = 0.11 and aOR 1.09 (95% CI, 0.91;1.30), p = 0.37], respectively. When evaluated as a dichotomous variable [≥ 11 vs. < 11 × 109/L] and by quartile, WBC count was not associated with graft failure at the patient and individual graft levels.
Conclusion: In this pooled analysis of individual patient data from two randomized clinical trials, WBC count was not associated with graft failure after CABG. The reported association between inflammation and CABG is likely mediated through other mechanisms, such as native coronary artery disease progression.
Impact on daily practice: The lack of a clear association between WBC count and graft failure suggests that pre-operative WBC count should not be routinely used as a predictor of graft failure after CABG.
期刊介绍：
Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields.
Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials.
Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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