{"title":"未成熟表面活性蛋白b型与冠状动脉搭桥术患者移植物通畅相关","authors":"Sonia Eligini PhD , Erica Gianazza PhD , Fabrizio Veglia PhD , Lisa Brocca BSc , Laura Cavallotti MD , Giulia Giusy Papaianni BSc , Daniele Andreini MD, PhD , Mauro Pepi MD , Gianluca Polvani MD , Elena Tremoli PhD , Alessandro Parolari MD , Piergiuseppe Agostoni MD , Cristina Banfi PhD","doi":"10.1016/j.jacadv.2025.102119","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery bypass graft (CABG) surgery is performed in patients with complex multivessel coronary artery disease, but long-term graft occlusion remains a major limitation. The immature surfactant protein type-B (proSP-B) has emerged as a predictor of adverse cardiovascular outcomes.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the relationship between preoperative plasma proSP-B and graft occlusion 18 months post-CABG. The aims were to evaluate whether elevated proSP-B could predict graft occlusion and to assess its predictive value within a multivariable model for long-term graft patency.</div></div><div><h3>Methods</h3><div>We evaluated proSP-B in relation to graft occlusion in 40 patients with occluded grafts (cases) and 130 patients without occlusions (noncases), with 18-month graft patency assessed by coronary computed tomography angiography and/or invasive angiography. Logistic regression assessed the association between proSP-B and graft occlusion. Predictive performance was evaluated using receiver-operating characteristic curves and category-free net reclassification improvement.</div></div><div><h3>Results</h3><div>Preoperative proSP-B was significantly elevated in cases compared to noncases (24.0 [IQR: 19.8-31.0] AU vs 19.4 [IQR: 14.0-25.0] AU; <em>P</em> = 0.002). In a multivariable analysis, proSP-B associated with increased risk of graft occlusion, even after adjusting for factors like D-dimer, left ventricular ejection fraction, and extracorporeal circulation time. Including proSP-B in a reference model improved the area under the curve from 0.7204 to 0.7733, significantly enhancing patient classification (net reclassification improvement = 0.43; SE = 0.18; <em>P</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>Elevated preoperative proSP-B is independently associated with 18-month graft occlusion following CABG. Including proSP-B improves existing predictive models, supporting its role as a novel biomarker for risk stratification in surgical revascularization.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102119"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Immature Surfactant Protein Type-B Associates With Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting\",\"authors\":\"Sonia Eligini PhD , Erica Gianazza PhD , Fabrizio Veglia PhD , Lisa Brocca BSc , Laura Cavallotti MD , Giulia Giusy Papaianni BSc , Daniele Andreini MD, PhD , Mauro Pepi MD , Gianluca Polvani MD , Elena Tremoli PhD , Alessandro Parolari MD , Piergiuseppe Agostoni MD , Cristina Banfi PhD\",\"doi\":\"10.1016/j.jacadv.2025.102119\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Coronary artery bypass graft (CABG) surgery is performed in patients with complex multivessel coronary artery disease, but long-term graft occlusion remains a major limitation. The immature surfactant protein type-B (proSP-B) has emerged as a predictor of adverse cardiovascular outcomes.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the relationship between preoperative plasma proSP-B and graft occlusion 18 months post-CABG. The aims were to evaluate whether elevated proSP-B could predict graft occlusion and to assess its predictive value within a multivariable model for long-term graft patency.</div></div><div><h3>Methods</h3><div>We evaluated proSP-B in relation to graft occlusion in 40 patients with occluded grafts (cases) and 130 patients without occlusions (noncases), with 18-month graft patency assessed by coronary computed tomography angiography and/or invasive angiography. Logistic regression assessed the association between proSP-B and graft occlusion. Predictive performance was evaluated using receiver-operating characteristic curves and category-free net reclassification improvement.</div></div><div><h3>Results</h3><div>Preoperative proSP-B was significantly elevated in cases compared to noncases (24.0 [IQR: 19.8-31.0] AU vs 19.4 [IQR: 14.0-25.0] AU; <em>P</em> = 0.002). In a multivariable analysis, proSP-B associated with increased risk of graft occlusion, even after adjusting for factors like D-dimer, left ventricular ejection fraction, and extracorporeal circulation time. Including proSP-B in a reference model improved the area under the curve from 0.7204 to 0.7733, significantly enhancing patient classification (net reclassification improvement = 0.43; SE = 0.18; <em>P</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>Elevated preoperative proSP-B is independently associated with 18-month graft occlusion following CABG. Including proSP-B improves existing predictive models, supporting its role as a novel biomarker for risk stratification in surgical revascularization.</div></div>\",\"PeriodicalId\":73527,\"journal\":{\"name\":\"JACC advances\",\"volume\":\"4 10\",\"pages\":\"Article 102119\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC advances\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772963X25005447\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772963X25005447","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景冠状动脉旁路移植术（CABG）可用于复杂的多支冠状动脉疾病患者，但长期的移植物阻塞仍然是一个主要限制。未成熟的表面活性剂蛋白b型（pro - b）已成为不良心血管结局的预测因子。目的探讨冠脉搭桥术后18个月术前血浆prob - b水平与移植物闭塞的关系。目的是评估prop - b升高是否可以预测移植物闭塞，并在多变量模型中评估其对移植物长期通畅的预测价值。方法采用冠状动脉计算机断层血管造影和/或有创血管造影对移植血管18个月的通畅度进行评估，并对40例有闭塞的移植血管患者（病例）和130例无闭塞的移植血管患者（非病例）进行prob - b检测。Logistic回归评估prob - b与移植物闭塞的关系。使用接受者-工作特征曲线和无类别净重分类改进来评估预测性能。结果术前有病例的prob水平明显高于无病例（24.0 [IQR: 19.8 ~ 31.0] AU vs 19.4 [IQR: 14.0 ~ 25.0] AU; P = 0.002）。在一项多变量分析中，即使在调整了d -二聚体、左心室射血分数和体外循环时间等因素后，普洛斯- b仍与移植物闭塞风险增加相关。纳入参考模型后，曲线下面积由0.7204提高到0.7733，显著提高了患者的分类能力（净重分类改善= 0.43;SE = 0.18; P = 0.02）。结论术前prob - b水平升高与冠脉搭桥术后18个月移植物闭塞独立相关。包括pro - b改进了现有的预测模型，支持其作为外科血运重建术风险分层的新型生物标志物的作用。
Immature Surfactant Protein Type-B Associates With Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting
Background
Coronary artery bypass graft (CABG) surgery is performed in patients with complex multivessel coronary artery disease, but long-term graft occlusion remains a major limitation. The immature surfactant protein type-B (proSP-B) has emerged as a predictor of adverse cardiovascular outcomes.
Objectives
The purpose of this study was to examine the relationship between preoperative plasma proSP-B and graft occlusion 18 months post-CABG. The aims were to evaluate whether elevated proSP-B could predict graft occlusion and to assess its predictive value within a multivariable model for long-term graft patency.
Methods
We evaluated proSP-B in relation to graft occlusion in 40 patients with occluded grafts (cases) and 130 patients without occlusions (noncases), with 18-month graft patency assessed by coronary computed tomography angiography and/or invasive angiography. Logistic regression assessed the association between proSP-B and graft occlusion. Predictive performance was evaluated using receiver-operating characteristic curves and category-free net reclassification improvement.
Results
Preoperative proSP-B was significantly elevated in cases compared to noncases (24.0 [IQR: 19.8-31.0] AU vs 19.4 [IQR: 14.0-25.0] AU; P = 0.002). In a multivariable analysis, proSP-B associated with increased risk of graft occlusion, even after adjusting for factors like D-dimer, left ventricular ejection fraction, and extracorporeal circulation time. Including proSP-B in a reference model improved the area under the curve from 0.7204 to 0.7733, significantly enhancing patient classification (net reclassification improvement = 0.43; SE = 0.18; P = 0.02).
Conclusions
Elevated preoperative proSP-B is independently associated with 18-month graft occlusion following CABG. Including proSP-B improves existing predictive models, supporting its role as a novel biomarker for risk stratification in surgical revascularization.
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