D-dimer is associated with arterial and venous coronary artery bypass graft occlusion

Abstract Objective In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusionat 18 months to identify a signature for graft occlusion. Methods A total of 330 patients undergoing primary electivecoronary artery bypass graftingwere enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiographyat 18 months follow-up, and 179 patients underwent coronary computed tomography angiography18 ± 2 months postoperatively. Results There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusionidentified that lower D-dimerlevels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P = .028) were related to overall graft occlusionat follow-up, along with an arterial graftother than the left internal thoracic artery(OR, 2.92; 95% CI, 1.24-6.9; P = .078); moreover, a venous graftemerged was possibly associated with graft occlusion(OR, 1.51; 95% CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimerlevels (OR, 2.67; 95% CI, 1.15-6.2; P = .022 and OR, 2.5; 95% CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusionat follow-up. Conclusions We identified D-dimeras a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graftfailure and identify new molecular targets to prevent this complication.